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CASE REPORT
Gastric Remnant Perforation after Roux-en-Y Gastric Bypass:

A Case Report and Literature Review

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Carlota Tuero , Gorka Docio , Victor Valenti , Alicia Artajona , Soledad Monton 5
AbstrAct
Aim and objective: The aim and objective of this article was to focus on long-term complications after bariatric surgery, which are usually
managed by general surgeons in the emergency department.
Background: Roux-en-Y gastric bypass (RYGBP) is one of the most commonly performed bariatric techniques in the world. Gastric remnant
complications after this procedure are infrequent and poorly known. Furthermore, the diagnosis of this pathology may be challenging.
Case description: We present the case of a 54-year-old woman with intense epigastric pain and history of uncomplicated laparoscopic RYGBP
18 years ago. After clinical, laboratory, and radiological examinations, the patient was diagnosed with a gastric remnant perforation. Laparoscopic
surgery was performed, and the perforation was successfully repaired with primary suture and omental patch.
Conclusion: Gastric remnant perforation after bariatric surgery is not frequent and usually appears several years after the procedure. This type
of pathology is presented without specific clinical manifestations and with few analytical alterations. Complementary radiological studies,
such as computed tomography (CT) scan, should be performed. However, pneumoperitoneum and extravasation of oral contrast are usually
absent. Depending on the size of the defect, primary suture or gastric remnant resection may be performed. Nevertheless, surgical treatment
should not be delayed.
Clinical significance: Long-term complications after bariatric surgery are in many circumstances managed by general practitioner surgeons.
The low incidence and scarce manifestations make the diagnosis of this pathology challenging. Furthermore, bariatric surgery is progressively
increasing its presence all over the world. Complications after this procedure must be known and kept in mind because an early diagnosis is
crucial to give a proper treatment and reduce morbidity and mortality.
Keywords: Bariatric surgery complications, Emergency surgery, Gastric bypass, Gastric remnant perforation, Pyloric perforation.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1458

bAckground 1,2,4,5 Department of Surgery, Hospital Garcia Orcoyen, Estella, Navarra,
Roux-en-Y gastric bypass (RYGBP) is the gold standard treatment for Spain
morbid obesity achieving long-term weight loss and comorbidity 3 Department of Surgery, Clinica Universidad de Navarra, Pamplona,
resolution. Complications after this type of surgery must be known, Navarra, Spain
especially long-term ones that sometimes are managed by general Corresponding Author: Carlota Tuero, Department of Surgery, Hospital
practitioner doctors. Garcia Orcoyen, Estella, Navarra, Spain, e-mail: ctuero@unav.es
Peptic ulcer disease is not frequent after RYGBP. Diagnosis is How to cite this article: Tuero C, Docio G, Valenti V, et al. Gastric
usually made after developing complications such as bleeding Remnant Perforation after Roux-en-Y Gastric Bypass: A Case Report
or perforation. However, literature is scarce, with 18 case reports and Literature Review. World J Lap Surg 2021;14(2):141–143.
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and 5 case series. The main clinical symptoms are unspecific with Source of support: Nil

epigastric abdominal pain associating with nausea and vomiting. Conflict of interest: None
Gastric remnant perforation is a rare entity that should not be
overlooked when exploring any patient with abdominal pain and
history of bariatric surgery. It is essential to take this pathology into
consideration in the differential diagnosis because altered anatomy
may change the clinical presentation and radiological findings in On physical examination, the patient was afebrile, without signs
bariatric patients. An early diagnosis and a proper treatment are crucial. of sepsis. She had right upper quadrant and epigastric tenderness
with deep palpation without rebound or percussion tenderness.
Abdominal auscultation was normal. Her body mass index was
cAse description 29 kg/m .
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A 54-year-old woman with a history of uncomplicated laparoscopic Laboratory examination showed anemia and elevated lipase
RYGBP and intense abdominal pain 18 years ago was admitted in and amylase activities. C-reactive protein level and white blood cell
the emergency department. She complained of epigastric pain for count were within normal limits.
about 1 week, which had progressed in the last few days, radiating No free air was seen on the abdominal X-ray, so a computed
to the back. She also developed symptoms such as anorexia, nausea, tomography (CT) with intravenous and oral contrast was performed.
and dizziness. Recent history was negative for smoking or alcohol Findings were correlative with acute pancreatitis, so the patient
abuse, but she claimed to have taken several doses of ibuprofen was admitted for observation. On clinical revaluation and despite
for lumbar pain. medical treatment, 48 hours after admission, abdominal pain

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