title: Giant perforated marginal ulcer after laparoscopicRoux-en-Y gastric bypass.
abstract: Perforation of a marginal ulcer (MU) is a complication ofRoux-en-Y gastric bypass that can be life-threatening. We report a case of a perforated MU that presented 7 months after surgery with several interesting points for discussion. Firstly, the presentation of the ulcer was cryptic with unreliable investigations. Secondly, the ulcer presented again even after anastomotic revision surgery. Finally, the ulcer and the sepsis associated with perforation presented after months of poor nutritional intake with profound hypoalbuminaemia. Perforated MUs causing malnutrition pose clinicians with the difficult decision of which operation to offer; patch repair, revision of the anastomosis or reversal surgery. This case illustrates that primary reversal surgery for a perforated recurrent MU may be the most appropriate surgical management in this clinical situation.
authors.affiliation: School of Surgery, The University of Western Australia, Perth, Australia Edward.Wang@health.wa.gov.au.
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.affiliation: School of Surgery, The University of Western Australia, Perth, Australia.|Hollywood Private Hospital, Western Surgical Health, Nedlands, Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Blackham
authors.affiliation: Hollywood Private Hospital, Western Surgical Health, Nedlands, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Tan
authors.affiliation: School of Surgery, The University of Western Australia, Perth, Australia.|Hollywood Private Hospital, Western Surgical Health, Nedlands, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hamdorf
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000628:therapy; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012086:Reoperation
chemical_list: D054328:Proton Pump Inhibitors
keywords: Bariatric Surgery; Gastrointestinal surgery; General surgery; Marginal Ulcer; Roux-en-y Gastric Bypass