Elliot C Pennington, Donald T Hess, Hiran C Fernando, Virginia R Litle. Boston University Medical Center
Introduction: Marginal ulcers (MUs) occur in approximately 1% of patients after bariatric surgery, especially Roux-en-Y gastric bypass. Rarely, MUs are refractory to maximal medical management and may require operative intervention.
Presentation of case: We present the case of a 32-year-old woman with intractable MUs after Roux-en-Y gastric bypass, refractory to maximal medical management. A recent upper endoscopy showed erosive gastritis, esophagitis, and three bleeding MUs, which required blood transfusion. She had a complicated surgical history with multiple intra-abdominal procedures, leading to a hostile abdomen. She underwent a successful right thoracoscopic (VATS) truncal vagotomy, which she tolerated well.
Conclusion: Marginal ulcers are a known complication of Roux-en-Y gastric bypass, and may be refractory to maximal medical management. Right thoracoscopic (VATS) truncal vagotomy is an effective therapy in selected patients.