The Roux-en-Y gastric bypass (RYGB) is the most used surgical technique for the treatment of morbid obesity with mortality
well established 0,22%. The laparoscopic approach is safe to perform the RYGB.
Case Report: Male, 28 years old, 178kg, 186cm height, 51.45 BMI and no comorbidities. Laparoscopic RYGB performed,
without complications, abdominal drainage tube placed by counter-opening, over the gastroenteroanatomosis. At 4
operative (PO) it was presented a low output fistula, started total parenteral nutrition. 15
PO day patient had a voluntary
ingestion of large amount of water. 17
PO night sweats,marked leukocytosis with a left shift. 18
PO performed CT scan
abdomen showing peri-hepatic fluid, during exploratory laparotomy, noted the presence of perforated duodenal ulcer of 2.5 cm
diameter anterior wall of the 1
portion of the duodenum. At 19
PO ICU, focus abdominal septic shock and death.
Peptic ulcer in the excluded segment after RYGB has been reported in 17 cases in the literature, all in open techniques. The
incidence of duodenal ulcer, up to 19 years after RYGB is approximately 0.25%. The time between RYGB and ulcer perforation
ranged from 20 days to 12 years. Six patients were previously reported in the literature with 33% mortality. There is one case of
acute perforated duodenal ulcer after RYGB open, with 3 weeks postoperatively.
So far has not been demonstrated another similar case reported in the literature, setting this as the first case report of
Perforated Duodenal Ulcer after Laparoscopic Gastric Bypass.
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