Role of Laparoscopy for the Diagnosis and Treatment of Perforated Duodenal Ulcers After Gastric Bypass Surgery

Khuram Khan, MD, Saqib Saeed, MD, Amrita Persaud, MS, RD, Sanjiv Gray, MD, Leaque Ahmed, MD

Department of Surgery, Harlem Hospital Center, Columbia University, New York, New York, USA (all authors).

ABSTRACT

Introduction: Gastric bypass is a commonly performed surgery for morbid obesity. Duodenal ulcer perforation after laparoscopic Roux-en-Y gastric bypass is a rare occurrence, with approximately 25 cases reported in the literature. The diagnosis of a perforated duodenal ulcer after gastric bypass can present a challenge. Most peptic ulcers after gastric bypass surgery occur in the Roux limb as marginal ulcers with the symptom of acute epigastric pain. Ulceration and then subsequent perforation in the secretory limb can also present with acute abdominal pain, with or without free air in the peritoneal cavity on imaging studies.

Case Description:We report 2 rare cases of laparoscopic repair of a perforated duodenal ulcer after gastric bypass surgery, treated laparoscopically with a Graham patch.

Conclusions: Diagnostic laparoscopy is recommended for post–Roux-en-Y gastric bypass patients presenting with acute abdominal symptoms, to rule out internal hernias and other rare life-threatening diseases, such as perforated duodenal ulcer. Surgeons should be aware of this entity and be certain to rule it out. If found during exploration, the duodenal ulcer can be repaired with a laparoscopic Graham patch.

Key Words: Abdominal pain, Graham patch repair, Laparoscopic gastric bypass, Perforated duodenal ulcer.

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