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Case Reports
. 2019 Nov 17:49:24-27.
doi: 10.1016/j.amsu.2019.11.006. eCollection 2020 Jan.

Perforated gastric ulcer post mini gastric bypass treated by laparoscopy: A case report

Diego Paim Carvalho Garcia  1 , Cyntia Ferreira Dos Reis  2 , Luiza Ohasi de Figueiredo  3 , Guilherme Vaz de Melo Mota  2 , Leonardo Quinete Guimarães  2 , Fernando Augusto de Vasconcellos Santos  1 , Luiz Ronaldo Alberti  4 , Thiago de Almeida Furtado  1
Affiliations
Case Reports

Perforated gastric ulcer post mini gastric bypass treated by laparoscopy: A case report

Diego Paim Carvalho Garcia et al. Ann Med Surg (Lond). .

Abstract

Introduction: Among the many techniques available for bariatric surgery, the Mini Gastric Bypass is a safe, technically simple and effective option. However, it may present with postoperative complications, being the perforated gastric ulcer one of the most relevant ones.

Presentation of case: A female patient of 41 years of age, with past medical history of a laparoscopic MGB performed 2 year before, presented with 12 hours of sharp and abruptly initiated abdominal pain, with diffuse presentation with suspected perforated acute abdomen after initial medical assessment and examination. Imaging propaedeutic was performed and confirmed a small pneumoperitoneum the patient was submitted to a laparoscopy with closure of the leak and omental patch (Graham's patch) after a thorough abdominal irrigation with saline solution. The patient was discharged from the hospital on the fourth day after surgery.

Discussion: One of the most common complications after and MGB surgery is the occurrence of gastric ulcers and main manifestation of the anastomotic marginal ulcers (MU) is the perforation. The treatment of the perforated peptic ulcer can be performed via laparoscopic or laparotomic approach. The main objective, regardless of the method used to access the abdominal cavity, is to identify and close the perforation.

Conclusion: The perforated gastric ulcer is a complication of the mini bariatric bypasses, and the laparoscopic treatment of the perforation associated with thorough irrigation for of the abdominal cavity and omentoplasty present good results for management of this complication.

Keywords: Bariatric surgery; Case report; Laparoscopy; Mini-gastric bypass; Peptic ulcer; Perforated ulcer.

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Conflict of interest statement

No conflicts of interest.

Figures

Image 1
Image 1
Abdominal Xray showing signs of pneumoperitoneum.
Image 2
Image 2
CTscan showing signs of pneumoperitoneum.
Image 3
Image 3
CTscan showing thickening of the ascending jejunal loop.
Image 4
Image 4
Methylene blue dye leak at the medial portion of the gastro-enteral anastomosis. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Image 5
Image 5
Illustration of a MGB from laparoscopic Roux-en-Y vs. Mini-gastric bypass for the treatment of morbid obesity: a 10-year experience.
See this image and copyright information in PMC

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