Duodenal Ulceration Erosion Into the Common Bile Duct Status Post-Roux-en-Y Gastric Bypass: A Case Report

Abstract

Peptic ulcer disease (PUD) affects approximately four million people worldwide. The most common etiologies of PUD are Helicobacter pylori (H. pylori) infections, chronic nonsteroidal anti-inflammatory drug (NSAID) use, and smoking. A rare cause of ulcer formation is documented in patients following Roux-en-Y gastric bypass (RYGB) procedures. Delayed treatment of these ulcers can further lead to ulcer perforation, erosion of the gastroduodenal artery (GDA), and fistula formation between the biliary structures and the gastrointestinal tract. Herein, we discuss the case of a 69-year-old female with an ulcer perforation 19 years after RYGB, resulting in an atypical ulcer erosion of the common bile duct without fistula formation.

Keywords: common bile duct (cbd); gastroduodenal artery; peptic ulcer disease; perforated peptic ulcer; roux-en-y gastric bypass.

Figure 1. Perforated viscus with anterior lucency indicative of an air-fluid level in a subhepatic fluid collection with adjacent small foci of intraperitoneal free-air along the anterior abdomen.

Figure 2. With retraction of the small bowel along an anterior plane, visualization of the posterior ulcer during laparotomy is evident with the common bile duct involved.

Figure 3. Angiogram showing perforation of the gastroduodenal artery with active contrast extravasation on the left. Post-coil embolization of the gastroduodenal artery demonstrated no residual bleeding on the right.