Massive GI Bleed from a Marginal Ulcer Eroding into the Left Gastric Artery

Leopoldo M. Baccaro, MD, Kalyan Vunnamadala, MD, Uchechukwu Stanley Ogu, MD, George Ibrahim, MD, Harjeet Kohli, MD, MRCP, FRCS

Department of General Surgery, Easton Hospital, Easton, PA, USA (Drs. Baccaro, Ogu, Ibrahim, and Kohli). Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA (Dr. Vunnamadala).

ABSTRACT

Introduction: Morbid obesity is an growing problem in the United States. As the incidence of morbid obesity increases, so does the number of surgical procedures for weight loss. Surgeons must learn to manage common complications of these procedures.

Case Descriptions and Operative Technique: We present two cases of massive upper gastrointestinal hemorrhage secondary to marginal ulcers eroding into the left gastric artery. A novel surgical technique has been described from these experiences to deal quickly with this highly fatal complication.

Discussion: General surgeons must be aware of the altered anatomy and physiology because they will encounter these patients in the emergency setting. It is important to be familiar with common complications, know how to identify them in a timely manner, and treat them accordingly. Marginal ulcers are frequent; however, torrential hemorrhage secondary to these is less common and extremely lethal.

Key Words: Laparoscopic Roux-en-Y gastric bypass, Marginal ulcer after gastric bypass, Gastrointestinal bleeding, Surgical technique, Emergency surgery.

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