title: Bleeding duodenal ulcer after Roux-en-Y gastric bypass surgery: the value of laparoscopic gastroduodenoscopy.
abstract: Roux-en-Y gastric bypass is a common surgical procedure used to treat patients with morbid obesity. One of the rare, but potentially fatal complications of gastric bypass is upper gastrointestinal bleeding, which can pose diagnostic and therapeutic dilemmas. This report describes a 39-year-old male with morbid obesity who underwent a Roux-en-Y gastric bypass. Three months postoperatively, he sustained repeated and severe upper attacks of upper gastrointestinal bleeding. He received multiple blood transfusions, and had repeated upper and lower endoscopies with no diagnostic yield. Finally, he underwent laparoscopic endoscopy which revealed a bleeding duodenal ulcer. About 5 ml of saline with adrenaline was injected, followed by electrocoagulation to seal the overlying cleft and blood vessel. He was also treated with a course of a proton pump inhibitor and given treatment for H pylori eradication with no further attacks of bleeding. Taking in consideration the difficulties in accessing the bypassed stomach endoscopically, laparoscopic endoscopy is a feasible and valuable diagnostic and therapeutic procedure in patients who had gastric bypass.
authors.affiliation: Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
authors.forename: Hussain
authors.initials: H
authors.lastname: Issa
authors.forename: Osama
authors.initials: O
authors.lastname: Al-Saif
authors.forename: Sami
authors.initials: S
authors.lastname: Al-Momen
authors.forename: Bahaa
authors.initials: B
authors.lastname: Bseiso
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Salem
mesh_terms: D000328:Adult; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004384:Duodenoscopy; D004386:Duodenum / Q000293:injuries* / Q000601:surgery; D015390:Gastric Bypass / Q000009:adverse effects*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery