title: Phytobezoar: a rare cause of late upper gastrointestinal perforation following gastric bypass surgery.
abstract: Marginal ulcers are a well described complication following Roux-en-Y gastric bypass. These may be a cause for perforation. We describe a case of upper gastrointestinal perforation 18 months following a laparoscopic Roux-en-Y gastric bypass that appeared to be caused by a food bezoar.  The perforation occurred at the site of the jejunojejunal anastomosis and was repaired after an exploratory laparotomy. After extracting the food debris (phytobezoar) through the perforation, direct closure resulted in an uneventful post-operative recovery. To our knowledge, this is the first  description of a food bezoar causing an intestinal perforation in such a manor after bariatric surgery. Patients should be educated carefully on what and how to eat after having undergone surgery for superobesity.
authors.affiliation: Bangor University, School of Medical Sciences, UK. john.sammut@gmail.com
authors.forename: S J
authors.initials: SJ
authors.lastname: Sammut
authors.forename: S
authors.initials: S
authors.lastname: Majid
authors.forename: S
authors.initials: S
authors.lastname: Shoab
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D001630:Bezoars / Q000209:etiology*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D007579:Jejunal Diseases / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D014675:Vegetables