Late gastrointestinal hemorrhage after gastric bypass.
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.
Braley
Scott C
SC
Division of Gastrointestinal Surgery, Department of Surgery, University of California, Davis, Medical Center, 2221 Stockton Blvd., 3rd Floor, Sacramento, CA 95817-1418, USA.
Nguyen
Ninh T
NT
Wolfe
Bruce M
BM
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