Piotr Gorecki, MD, Victor Gazivoda, BS, Gabriel Rivera, MD, Mukul Arya, MD. New York Presbyterian Brooklyn Methodist Hospital
Introduction: Roux en-Y gastric bypass (RYGB) is one of the initial and most studied weight reduction procedures and remains the gold standard for comparison in bariatric surgery clinical outcomes. Although RYGB is an effective procedure for weight loss, it has been less popular over last several years because of increased morbidity compared to the more utilized vertical sleeve gastrectomy (VSG). Early complications of RYGB include bleeding, perforation, or leakage. Late complications include internal hernias, small bowel obstruction, anastomotic stenosis, marginal ulcers, and gastrogastric fistulas.
Case Report: A 50-year old female with a past medical history of morbid obesity, diabetes mellitus type 2, hypertension, GERD, peptic ulcer disease, cholelithiasis, liver dysfunction with ascites, asthma, and a past surgical history of RYGB (11 years ago) presented to our institution with acute on chronic abdominal pain associated with nausea, vomiting, dysphagia, inability to eat and maintain hydration, and an additional weight loss of about 100 lbs. over the last year. In addition, the patient was a chronic opioid and NSAID user, had an extensive smoking history, and had not followed with her surgeon for 11 years. At the time of presentation, the patient weighed 82 lbs (BMI: 13.2), had normal vital signs, and appeared cachectic. An upper gastrointestinal study followed by an upper endoscopic examination demonstrated complete obliteration of the gastrojejunal anastomosis and revealed a 2-cm long gastrogastric fistula originating from the distal end of the gastric pouch to the lesser curvature of the excluded stomach. After conservative measures were initiated to hydrate and metabolically stabilize the patient, the decision was made to proceed with diagnostic laparoscopy and surgical placement of a gastrostomy tube to the gastric remnant. The patient was discharged after tolerating a full liquid diet and gastrostomy tube feedings, for plan of future revision of gastrojejunostomy when optimal nutritional status is achieved.
Conclusions: Late complications of RYGB occur at a rate of 15-20%. Major risk factors for anastomotic complications include non-compliance, smoking, and opiate and NSAID abuse. Though abdominal pain, anastomotic stenosis, marginal ulcers, and fistulas are relatively common late complications of RYGB, complete obliteration of the gastrojejunal anastomosis has not been well described in the literature. This case demonstrates the importance of long term follow up post RYGB for early diagnosis of late complications and brings attention to this rare, but possible sequele that can arise in patients after RYGB. Contrast radiograms and upper endoscopic photographs will be presented.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87936
Program Number: P169
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster