Perforation of old gastrojejunal anastomotic site presenting as acute abdomen: a case report

Tharun Ganapathy C., Jeyakumar S., Manimaran P., Sidhu Sekhar


Complications at the gastrojejunal anastomosis site after a bypass procedure is challenging in terms of diagnosis, therapy and prevention. Complications most frequently encountered are marginal ulcer, bleeding and stenosis, while perforation secondary to ulceration at anastomosis site is very rare and seldom reported. Direct exposure of gastric acid is the important cause of ulcer formation which may get further complicated by the use of NSAID's, alcohol intake and smoking. We report a case of 47-year-old male who developed perforation at the gastrojejunal anastomotic site of old gastrojejunostomy for peptic ulcer disease.


Gastrojejunal anastomosis, H. pylori, Peptic ulcer disease, Perforation

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Zinner MJ, Ashley SW. Maingot's abdominal operations.12th ed. McGraw-Hill Education; 2012.

Fan X, Kwan C, Riall TS, Sellin JA. Gastric ulcer at the anastomosis site perforated into the liver 3 years after Roux-en-Y gastric bypass surgery. Gastrointest Endosc. 2008;68:769.

Hedberg J, Hedenstrom H, Nilsson S, Sundbom M, Gustavsson S. Role of gastric acid in stomal ulcer after gastric bypass. Obes Surg. 2005;15:1375-8.

Suter M, Giusti V. Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures. Swiss Med Rev. 2013;9(379):658-63.

Sapala A, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obesity Surg. 1998;8(5):505-16.

Dallal M, Bailey LA. Ulcer disease after gastric bypass surgery. Surg Obesity Related Diseases. 2006;2(4):455-9.

Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surgical Endoscopy Other Interventional Tech. 2007;21(7):1090-4.

Wendling MR, Linn JG, Keplinger KM. Omental patch repair effectively treats perforated marginal ulcer following Roux-en-Y gastric bypass. Surg Endoscopy. 2013;27(2):384-9.

Sacks BC, Mattar SG, Qureshi FG. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases. 2006;2(1):11-6.

Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases. 2009;5(3):317-22.

Macgregor AMC, Pickens NE, Thoburn EK. Perforated peptic ulcer following gastric bypass for obesity. Am Surgeon. 1999;65(3):222-5.

Lublin M, McCoy M, Waldrep DJ. Perforating marginal ulcers after laparoscopic gastric bypass. Surgical Endoscopy Other Interventional Techniques. 2006;20(1):51-4.