Clinical Overview > Condition/ Syndrome > Gastrointestinal perforation
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Department of Digestive and Extra-Digestive Surgery, Porto, Portugal
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Department of Digestive and Extra-Digestive Surgery, Porto, Portugal
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Department of Digestive and Extra-Digestive Surgery, Porto, Portugal
Obesity Treatment Center - Unidade de Tratamento Cirúrgico de Obesidade (UTCO), Porto, Portugal
CAC ICBAS-CHP, Porto, Portugal
I3S, Glycobiology and Cancer Research, Porto, Portugal
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Department of Digestive and Extra-Digestive Surgery, Porto, Portugal
Obesity Treatment Center - Unidade de Tratamento Cirúrgico de Obesidade (UTCO), Porto, Portugal
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Department of Digestive and Extra-Digestive Surgery, Porto, Portugal
Obesity Treatment Center - Unidade de Tratamento Cirúrgico de Obesidade (UTCO), Porto, Portugal
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Department of Digestive and Extra-Digestive Surgery, Porto, Portugal
Obesity Treatment Center - Unidade de Tratamento Cirúrgico de Obesidade (UTCO), Porto, Portugal
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Department of Digestive and Extra-Digestive Surgery, Porto, Portugal
Obesity Treatment Center - Unidade de Tratamento Cirúrgico de Obesidade (UTCO), Porto, Portugal
CAC ICBAS-CHP, Porto, Portugal
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Summary
Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy.
Learning points
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Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures in bariatric surgery.
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Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis.
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The pathophysiology of this perforation is not clear, but several mechanisms have been proposed. Helicobacter pylori has been implicated.
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Clinicians should be aware and have a low threshold for diagnostic laparoscopy for a patient who has acute abdominal pain after RYGB, despite negative diagnostic measures.
