Abstract
The Management of GI bleeding after Gastric Bypass Surgery
Highlights
Obesity rates in the United States continue to increase
We present a case of life-threatening hemorrhage from multiple gastric ulcerations in a patient after Roux-en-Y gastric bypass (RNYGB), and a management algorithm
The patient was taken to the operating room the following day for laparoscopy, and an intra-operative endoscopy via gastrostomy of the gastric remnant
Summary
Obesity rates in the United States continue to increase. Currently, 34.9%of adults are considered obese (BMI>30mg,/kg2) [1,2], 5.1% of these individuals qualify as morbidly obese (Body Mass Index>40mg/ kg2) and are at increased risk of obesity-related complications including early death [3]. In 2014, she presented to our ED with complaint of melanotic stool and diffuses abdominal pain of several weeks She was initially tachy cardic, mildly hypotensive, and her initial hemoglobin levels was 7.4g/dl. Given her prior history and negative work-up, our team opted to perform a Technetium-99m (99mTc) red blood cell scan initially. This was inconclusive, there was a “questionable faint focus of uptake confined to the left upper quadrant”, which persisted on subsequent scans (Figure 1). The patient was taken to the operating room the following day for laparoscopy, and an intra-operative endoscopy via gastrostomy of the gastric remnant This revealed the gastric remnant to be distended and full of clotted blood. Post-operatively, the patient recovered well and has had resolution of her symptoms
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