Presentation
Epigastric pain.
Patient Data
Roux en y gastric bypass with subtle thickening and surrounding fat stranding associated with the gastrojejunostomy. Associated adjacent fine locules of free air.
Case Discussion
Operative report excerpt: "The omentum and left liver were adhered to the roux limb. These were taken down revealing a 1 cm perforation just distal to the gastrojejunostomy. This was closed with omental patch inlay."
This case illustrates a complication of RYGB called marginal ulceration, which is a mucosal erosion that most commonly develops on the jejunal side of the gastrojejunal anastomosis. Although subtle, the fact that most of the free air was located in the upper abdomen and subtle surrounding stranding (with knowledge of this risk factor) should be sufficient to suggest this diagnosis and appropriately direct surgical therapy.
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