Published online Dec 16, 2014. doi: 10.4253/wjge.v6.i12.625
Revised: October 15, 2014
Accepted: October 28, 2014
Published online: December 16, 2014
Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidence of bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.
Core tip: Bleeding duodenal ulcer after Roux-en-Y gastric bypass for morbid obesity is a rare, but life threatening situation. Anatomic rearrangement after bariatric operation prevents upper endoscopy from displaying stomach remnant, duodenum, and proximal jejunum. The bleeding duodenal ulcer was identified at emergency laparotomy by intraoperative endoscopy through gastrotomy. After surgical hemostasis, duodenal ulcer excision and completion of the remnant gastrectomy the postoperative course was uneventful.