title: Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature.
abstract: 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.
authors.affiliation: Arpad Ivanecz, Stojan Potrč, Department of Abdominal and General Surgery, University Medical Center Maribor, 2000 Maribor, Slovenia.
authors.forename: Arpad
authors.initials: A
authors.lastname: Ivanecz
authors.affiliation: Arpad Ivanecz, Stojan Potrč, Department of Abdominal and General Surgery, University Medical Center Maribor, 2000 Maribor, Slovenia.
authors.forename: Marko
authors.initials: M
authors.lastname: Sremec
authors.affiliation: Arpad Ivanecz, Stojan Potrč, Department of Abdominal and General Surgery, University Medical Center Maribor, 2000 Maribor, Slovenia.
authors.forename: Davorin
authors.initials: D
authors.lastname: Ceranić
authors.affiliation: Arpad Ivanecz, Stojan Potrč, Department of Abdominal and General Surgery, University Medical Center Maribor, 2000 Maribor, Slovenia.
authors.forename: Stojan
authors.initials: S
authors.lastname: Potrč
authors.affiliation: Arpad Ivanecz, Stojan Potrč, Department of Abdominal and General Surgery, University Medical Center Maribor, 2000 Maribor, Slovenia.
authors.forename: Pavel
authors.initials: P
authors.lastname: Skok
keywords: Bleeding; Duodenal ulcer; Emergency surgery; Endoscopy; Roux-en-Y gastric bypass