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Rycx A, Maes H, Van Nieuwenhove Y. A rare complication of laparoscopic Roux-en-Y gastric bypass: case report of gastric remnant necrosis. Acta Chir Belg 2023; 123:62-64. [PMID: 33998947 DOI: 10.1080/00015458.2021.1881335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Gastric remnant necrosis is a very rare, but potential life-threatening complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). We report a case of gastric remnant necrosis that was complicated by peritonitis and resulted in septic shock in a 49-year-old woman who had undergone a LRYGB three months prior to admission. An emergent laparoscopy with subtotal gastrectomy was performed. The patient was treated for septic shock and could leave the hospital in a good condition. Potential etiological factors for gastric remnant necrosis were elaborated.
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Affiliation(s)
- Astrid Rycx
- General Surgery, Ghent University, Ghent, Belgium
| | | | - Yves Van Nieuwenhove
- Gastrointestinal and Bariatric Surgery, Universitair Ziekenhuis Gent, Gent, Belgium
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Duza G, Palermo M, Serra E, Davrieux F. Chronic Gastric Dilation-Surgical Management. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34534020 DOI: 10.1089/lap.2021.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic dilation of the gastric remnant is a rare complication, although it can be serious. It is due to an exaggerated distension of the gastric remnant after a Roux-en-Y gastric bypass (RYGB). Clinical suspicion and computed tomography (CT) are essential for its diagnosis. Its treatment is by means of a decompressive gastrostomy, which can be percutaneous or surgical, an option that can be carried out in certain patients. We present a clinical case of chronic dilation of the gastric remnant and its laparoscopic surgical resolution. Methods: We present a clinical case of a 67-year-old patient who underwent a RYGB. An abdominal CT scan showed chronic dilation of the gastric remnant. A laparoscopic biopsy and a laparoscopic-assisted percutaneous gastrostomy were performed. Conslusion: The combined percutaneous laparoscopic approach is a good option for cases of chronic gastric dilations of unknown origin, allowing to discover and treat its causes.
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Affiliation(s)
- Guillermo Duza
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Department of Bariatric Surgery, DIAGNOMED, Buenos Aires, Argentina
| | - Mariano Palermo
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Department of Bariatric Surgery, DIAGNOMED, Buenos Aires, Argentina
- Department of Percutaneous Surgery, DAICIM Foundation, Buenos Aires, Argentina
| | - Edgardo Serra
- Department of Percutaneous Surgery, DAICIM Foundation, Buenos Aires, Argentina
- Department of Bariatric Surgery, CIEN Center, Corrientes, Argentina
| | - Federico Davrieux
- Department of Percutaneous Surgery, DAICIM Foundation, Buenos Aires, Argentina
- Department of General Surgery, Sanatorio de la Mujer, Rosario, Argentina
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Gastric Remnant Perforation Caused by Peterson's Hernia Following One Anastomosis Gastric Bypass: a Rare Complication. Obes Surg 2021; 30:3229-3232. [PMID: 32144635 DOI: 10.1007/s11695-020-04524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) has gained popularity over the recent years; it appears to be an effective bariatric procedure with acceptable weight loss, co-morbidity resolution, and complication rates in the short and medium term. However, it still continues to have concerns in the bariatric community due to a spectrum of potential complications. To our knowledge, there are few published cases of internal hernia, but no published reports of gastric remnant perforation following OAGB. CASE PRESENTATION We report a case of a 32-year-old female who developed a perforation of the remnant stomach along the gastric fundus secondary to bowel obstruction 5 years after OAGB. The perforation was managed by stapled resection of the perforated fundus and closure of Peterson's space for potential hernia as a causative factor, and the patient had a smooth postoperative recovery. DISCUSSION Early diagnosis is crucial in post bariatric emergencies with a low threshold of early intervention. Gastric remnant perforation was previously described in some reports following Roux-en-Y gastric bypass (RYGB) but not after OAGB. Etiology of perforation can be rationalized to primary gastric remnant pathology or secondary to external factors such as back pressure of mechanical/functional bowel obstruction. CONCLUSION Peterson's hernia and gastric remnant perforation are rare, yet serious, complications that need to be kept in mind while dealing with post-OAGB patients presenting with abdominal pain. Early diagnosis and treatment are essential for a better outcome.
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Davrieux CF, Palermo M, Serra E, Acquafresca P, Giménez ME. Acute Gastric Dilation of the Post-Roux-en-Y Gastric Bypass Remnant Stomach: Image-Guided Surgery Approach. J Laparoendosc Adv Surg Tech A 2021; 31:166-170. [DOI: 10.1089/lap.2020.0729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Carlos Federico Davrieux
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- Department of General Surgery, Sanatorio de la Mujer, Rosario, Argentina
| | - Mariano Palermo
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- Department of Bariatric Surgery, Diagnomed, Buenos Aires, Argentina
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Serra
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- Department of Bariatric Surgery, CIEN Center, Corrientes, Argentina
| | - Pablo Acquafresca
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
| | - Mariano E. Giménez
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- IRCAD (Institute for Research on Cancer of the Digestive System), Strasbourg, France
- IHU-Strasbourg, (Institute Hopitalo-Universitaire), Strasbourg, France
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Ulcer Disease in the Excluded Segments after Roux-en-Y Gastric Bypass: a Current Review of the Literature. Obes Surg 2020; 31:1280-1289. [PMID: 33230760 PMCID: PMC7921036 DOI: 10.1007/s11695-020-05123-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023]
Abstract
Ulcer disease in excluded segments after Roux-Y gastric bypass (RYGB) is rare but can evolve into a life-threatening situation. The excluded segments exhibit a different behavior from that of non-altered anatomy; perforated ulcers do not result in pneumoperitoneum or free fluid, and therefore must be met with a low threshold for surgical exploration. The anatomical changes after RYGB impede routine access to the remnant stomach and duodenum. There are various options to address bleeding or perforated ulcers. While oversewing and drainage preserves the anatomy and forgoes resection, remnant gastrectomy offers a definitive solution. The importance of traditional risk factors such as smoking or use of non-steroidal anti-inflammatory drugs is unclear. Eradication of Helicobacter pylori and secondary prophylaxis with proton-pump inhibitors is advisable, albeit in double-dose.
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Zarrin A, Sorathia S, Choksi V, Kaplan SR, Kasmin F. Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report. World J Gastrointest Endosc 2020; 12:297-303. [PMID: 32994860 PMCID: PMC7503611 DOI: 10.4253/wjge.v12.i9.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/04/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery. Furthermore, acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously. Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach. Traditionally, this necessitates surgical intervention. Recently, however, the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management.
CASE SUMMARY A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension, nausea, and melena of two days duration. His imaging illustrated a massively distended stomach. A nasogastric tube did not result in drainage of fluid or decompression of his abdomen. His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended "fluid"-filled gastric remnant. An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant. Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum. The patient underwent emergent angiography with embolization of the gastroduodenal artery. He was discharged with a stable hemoglobin level and resolution of symptoms. Healing superficial gastric ulcers were visualized on a follow-up endoscopy. Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated, and successful eradication was achieved.
CONCLUSION This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound-directed transgastric intervention.
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Affiliation(s)
- Arash Zarrin
- Department of Internal Medicine, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Sufian Sorathia
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Vivek Choksi
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Steven Robert Kaplan
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Franklin Kasmin
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
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Perduca P, Waisberg DR, Pinheiro RSN, Hourneaux-DE-Moura EG, D'Albuquerque LAC, Andraus W. A POSSIBLE COMPLICATION AFTER LIVER TRANSPLANTATION IN A GASTRIC BYPASS BARIATRIC PATIENT: DON'T FORGET THE EXCLUDED STOMACH! CASE REPORT AND REVIEW OF THE LITERATURE. ACTA ACUST UNITED AC 2020; 33:e1510. [PMID: 32844879 PMCID: PMC7448854 DOI: 10.1590/0102-672020190001e1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Daniel Reis Waisberg
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Wellington Andraus
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Dai L, Shah MM, Rosenblatt S. Perforated gastric remnant ulcer after laparoscopic gastric bypass. BMJ Case Rep 2018; 2018:bcr-2017-222190. [PMID: 29622702 DOI: 10.1136/bcr-2017-222190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ulcer perforation in the excluded stomach and duodenum is a rare complication after Roux-en-Y gastric bypass (RYGB). Pathogenesis of these ulcers are multifactorial. We report a case of perforated gastric remnant ulcer in a 54-year-old woman who had undergone a laparoscopic RYGB 5 years previously. The perforation was successfully repaired with an omental patch. We also present a review of the literature of similar cases.
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Affiliation(s)
- Lu Dai
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Mihir M Shah
- Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Steven Rosenblatt
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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