Spontaneous Gastrogastric Fistulalization After Being Left in Discontinuity of Proximal Gastric Pouch and Roux Limb Due to Catastrophic Gastrojejunal Marginal Ulcer Perforation

John S. Paek, DO, Chen Chen, MD, Nabil Tariq, MD

Houston Methodist Hospital, Houston, USA (all authors).

ABSTRACT

Background: In this case report, a patient had complicated marginal ulcer perforation that led to gastrointestinal tract discontinuity with future plan for reversal. However in this novel case, the patient had spontaneous continuity, which prevented another major, complicated surgery.

Methods: A 59 year-old female who underwent exploratory laparotomy due to a very complicated perforated marginal ulcer that failed multiple medical/endoscopic treatments. Patient was left in discontinuity due to tissue friability, and was left with gastric tube to gastric pouch and gastric remnant, with plans to do anastomosis in three to six months.

Results: There was a spontaneous fistula that formed between the prior gastric pouch and gastric remnant with two gastric tubes found within gastric remnant.

Conclusion: Due to spontaneous gastrogastric fistulalization, or spontaneous gastric bypass reversal, our patient did not require another major complicated surgery.

Key Words: Marginal ulcer perforation, Discontinuity, Spontaneous reconstitution of gastrointestinal tract.

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