Laparoscopic Repair of Perforated Marginal Ulcer After Roux-en-Y Gastric Bypass: A Case Report and Review of Literature

Introduction: A possible complication that may present late after Roux-en-Y gastric bypass is the development of marginal ulcer at the gastrojejunostomy site. We discuss here an emergency presentation of a case with a delayed perforation at the anastomosis 5 months after surgery which dealt successfully with the laparoscopic approach. Case Presentation: A 45-year-old female presented to the emergency department for evaluation of severe upper abdominal pain. Her past historywassignificant for laparoscopic Roux-en-Y gastric bypass surgery for weight lossdonein Oct 2016andfurther denied any history of chronic medication, alcoholism, smoking or any co-morbidity. She was examined and found to have a tenderness all over the abdomen with sluggish bowel sounds and decreased air entry at bases bilaterally, more so on the left side. Portable CXR revealed air under the diaphragm and an obliterated left costophrenic angle. A repeat CT scan with gastrograffin contrast was carried out and findings confirmed a perforation at the site of gastrojejunal anastomosis with free fluid in the pelvis and flanks. She underwent laparoscopic exploration and repair of anastomotic perforation with omental patch and was discharged in a healthy fashion on her 7th postoperative day. Conclusions: This case report corroborates with literature availablefrommanysources that marginal ulcer perforation isoneof the serious complications after Roux-en-Y gastric bypass and may present early in the first few months or as a delayed entity years after the surgery. Once diagnosed, urgent intervention is required and laparoscopic repair has shown itself a safe and effective treatment strategy where facilities are available.