title: Late gastrointestinal hemorrhage after gastric bypass.
abstract: BACKGROUND
  Hemorrhage from the excluded gastric segment or duodenum after gastric bypass is an uncommon late complication and poses both diagnostic and therapeutic difficulties. We describe 4 cases of late gastrointestinal (GI) hemorrhage after gastric bypass.
  
  
  METHODS
  4 patients who underwent previous Roux-en-Y gastric bypass (RYGBP) presented for management of severe GI hemorrhage. Their history, diagnostic work-up, management, and surgical pathology are reviewed.
  
  
  RESULTS
  In all 4 patients, preoperative diagnostic evaluation including nuclear scintigraphy, endoscopy, and angiography failed to localize the source of bleeding. Intraoperative endoscopy of the gastric remnant and subtotal gastrectomy were performed in all 4 patients. The mean time interval between RYGBP operation and gastrectomy was 15.5 years (range 13-17 years). In 3 of 4 patients, the source of bleeding was documented on pathologic examination of the resected gastric remnant and duodenum. At a mean follow-up of 15 months, none of the patients developed recurrent GI hemorrhage.
  
  
  CONCLUSIONS
  GI hemorrhage after RYGBP can be a diagnostic and therapeutic dilemma. Intraoperative endoscopy of the excluded stomach and subtotal gastrectomy should be considered when the source of bleeding is not identified by conventional diagnostic techniques.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, University of California, Davis, Medical Center, 2221 Stockton Blvd., 3rd Floor, Sacramento, CA 95817-1418, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Braley
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D013997:Time Factors