CASE REPORT   

Chirurgia 2020 December;33(6):341-3

DOI: 10.23736/S0394-9508.20.05078-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

A rare complication of single anastomosis gastric bypass surgery: perforated marginal ulcer

Fahed MEREI ¹, Ronit WITZTUM ², Ibrahim ABU SHAKRA ¹, Amitai BICKEL ^{1, 3}, Kamal KHATIB ¹, Samer GANAM ¹, Maxim BEZ ¹, Doron FISCHER ⁴, Eli KAKIASHVILI ¹ ✉

¹ Department of Surgery A, Galilee Medical Center, Nahariya, Israel; ² Department of Surgery B, Carmel Medical Center, Haifa, Israel; ³ Faculty of Medicine in the Galilee, Bar-Ilan University, Safad, Israel; ⁴ Department of Radiology, Galilee Medical Center, Nahariya, Israel

The single anastomosis gastric bypass (SAGB), also known as the mini gastric bypass, is a modification of the loop gastric bypass. The SAGB is technically easier to perform than a Roux-en-Y gastric bypass because it requires only one anastomosis. Marginal ulcer disease is a common complication of gastric bypass surgery, yet perforation of the ulcer is rare. We present a 46-year-old man who presented with chest and upper abdominal pain one year after undergoing SAGB. CT scans of the abdomen and pelvis demonstrated a number of small bowel loops with a thickened wall in the left abdomen, epigastric free abdominal air of a medium-large amount and a small amount of fluid between the intestinal loops and in the pelvis. An urgent exploratory laparoscopy revealed a perforation of a marginal ulcer. Recovery was uneventful. Our patient did not have any of the known risk factors for a marginal ulcer, nor did he have any ulcer specific symptoms prior to his admission. This case demonstrates the possible occurrence of a perforated ulcer following gastric bypass surgery, even among patients without risk factors.

KEY WORDS: Bariatric surgery; Peptic ulcer; Gastric bypass