Peetermans Maxime, Vellemans Jana, Jutten Guido, D'hooge Pieter, Delvaux Peter, Huysentruyt Frederik, Van Hootegem Anneleen, Callens Jos, Peetermans Olivier
Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Trainee Abdominal Surgery, AZ Klina, Brasschaat, Belgium.
Acta Chir Belg. 2021 Apr;121(2):115-121. doi: 10.1080/00015458.2019.1642017. Epub 2019 Jul 23.
Because of the increasing prevalence of obesity and bariatric surgery (Roux-en-Y gastric bypass (RYGB) as the gold standard), there is a still growing population of people with altered post-operative anatomy. Although the most common early and late complications following RYGB are well known, they can still be difficult to diagnose. The altered anatomy after RYGB can create a real diagnostic and therapeutic challenge since routine examinations can be negative.
We present a rare case of a 38-year-old woman with acute abdominal pain and a history of RYGB who proved to have a duodenal perforation in the absence of free air on radiologic examination. The perforation was closed laparoscopically and proton pump inhibitors were administered.
Perforations of the excluded segment in RYGB patients are rare and represent a diagnostic challenge, as pneumoperitoneum is usually absent and the excluded segment is difficult to access. Despite negative diagnostic findings, laparoscopic exploration should always be considered.
