Emergent reversal of gastric bypass due to severe GI hemorrhage from marginal ulcer eroding into right gastroepiploic artery

Nicholas Mouw, MD, Reid Adam, MD, John Mellinger, MD. Southern Illinois University

Introduction: One of the known complications from roux en y gastric bypass is marginal ulceration at the gastrojejunostomy.  Marginal ulcers can present in many different ways including gastrointestinal hemorrhage.  This is typically due to erosion into the blood supply of the bowel at the anastomotic site.  Potential therapy for significant bleeding is endoscopic control, angiographic embolization, or surgical revision.

Materials and Methods: We present a unique case of a severe GI hemorrhage caused by erosion of a marginal ulcer into the right gastroepiploic artery in a 31 year old female status post roux en y gastric bypass 5 years earlier.   This recurred despite several endoscopic interventions and angiographic embolization.  Taking into consideration the patient's compliance, anatomy and severe malnutrition, the operative repair undertaken was emergent laparoscopic reversal of gastric bypass with resection of the roux limb, gastro-gastric anastomosis, gastrostomy tube and jejunostomy tube placement.  After a prolonged recovery due to her malnutrition, the patient was discharged home in good condition.  We reviewed the literature regarding emergent revision and reversal of gastric bypass for acute GI bleeding.

Conclusion: General surgeons should be involved early in the care of gastric bypass patients with significant gastrointestinal bleeding from marginal ulcers.  There are multiple case reports for emergent revision of gastric bypass for GI bleeding in the literature.  However, there is little data regarding emergent reversal of gastric bypass for acute GI bleeding.

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