A Rare Cause of Bleeding After Roux-en-Y Gastric Bypass

Pan, Alexander; Sahni, Sakshi; Khan, Ruben; Boulay, Brian R.

doi:10.14309/00000434-201810001-02020

Cited by 2 publications

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“…Marginal ulcers are easily diagnosed and treated with conventional upper endoscopy. However, ulceration of the gastric remnant or duodenum is rare, with approximately 25 reported cases in the literature[ 5 - 10 ]. Risk factors for developing such ulcers include hyperacidity of the gastric remnant without the buffering effect of ingested food, bile acid reflux, NSAIDs use, and Helicobacter pylori infection[ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report

Zarrin

Sorathia

Choksi

et al. 2020

WJGE

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BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery. Furthermore, acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously. Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach. Traditionally, this necessitates surgical intervention. Recently, however, the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management. CASE SUMMARY A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension, nausea, and melena of two days duration. His imaging illustrated a massively distended stomach. A nasogastric tube did not result in drainage of fluid or decompression of his abdomen. His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended "fluid"-filled gastric remnant. An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant. Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum. The patient underwent emergent angiography with embolization of the gastroduodenal artery. He was discharged with a stable hemoglobin level and resolution of symptoms. Healing superficial gastric ulcers were visualized on a follow-up endoscopy. Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated, and successful eradication was achieved. CONCLUSION This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound-directed transgastric intervention.

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Section: Discussionmentioning

confidence: 99%

Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report

Zarrin

Sorathia

Choksi

et al. 2020

WJGE

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Tratamiento conservador para hemorragia posterior a bypass gástrico reporte de caso

2023

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La hemorragia es una complicación rara en la cirugía bariátrica, donde su prevalencia es de hasta 4% de procedimientos, y esta variará de acuerdo con los distintos procedimientos realizados, además la hemorragia que ocurre posterior a una cirugía bariátrica se clasifica como aguda, temprana, tardía y crónica, también depende del lugar de la hemorragia debido a que puede ser intraabdominal e intraluminal. Paciente masculino de 29 años de edad, con antecedentes de diabetes mellitus tipo 2 y obesidad grado I, a quien se le realizó un bypass gástrico, presenta al post quirúrgico inmediato melenas por varias ocasiones, a esto se le suma astenia generalizada, lo que lleva a plantear el diagnóstico de hemorragia digestiva. El tratamiento adecuado es la cirugía, sin embargo, se decide realizar tratamiento conservador. Este manejo es expectante ya que ayuda a resolver en conjunto la mayoría de los casos, así mismo permite al paciente mejorar su cuadro clínico y reduce la posibilidad de que existan signos de alerta, en esta ocasión presentó una eficacia total con una excelente recuperación

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A Rare Cause of Bleeding After Roux-en-Y Gastric Bypass

Cited by 2 publications

References 0 publications

Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report

Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report

Tratamiento conservador para hemorragia posterior a bypass gástrico reporte de caso

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