Perforated Marginal Ulcer, Post Roux-En-Y Surgery without Risk Factors: A Case Report

Abstract

A marginal ulcer is a commonly occurring complication of Roux-en-Y gastric bypass, with an occurrence rate of up to 16%. However, perforation of such ulcers is rare, affecting approximately 1% of cases and typically manifesting at a later stage. Moreover, risk factors, whether surgical or non-surgical, are present in nearly all patients reported in the literature, with only 0.2% found to have none. This case report focuses on a 32-year-old female patient who presented with severe left-sided abdominal pain. She had a history of undergoing Roux-en-Y surgery two years prior. A CT scan of the abdomen revealed the presence of free air and contrast leak, indicative of a perforated marginal ulcer. The patient subsequently underwent a laparoscopic repair of the marginal ulcer, involving the use of an omental patch. In patients experiencing recurrent abdominal pain, the suspicion of a marginal ulcer should arise, prompting the inclusion of upper endoscopy as part of the diagnostic workup. The feasibility of laparoscopic repair with an omental patch has been demonstrated, and patients are advised to undergo follow-up endoscopy. Doctors should have a high suspicion index for perforation of marginal ulcer with any patient after bariatric surgery despite the absence of risk factors.