Kabelitz Nina, Brinken Berit, Bumm Rudolf
Department of Visceral Surgery, Kantonsspital Graubünden, Chur, Switzerland.
J Surg Case Rep. 2020 Feb 10;2020(2):rjz383. doi: 10.1093/jscr/rjz383. eCollection 2020 Feb.
Roux-en-Y gastric bypass (RYGB) is one of the most frequently performed bariatric procedures worldwide. The postoperative incidence of cholelithiasis after RYGB is higher than in the general population (30% vs. 2-5%), because the altered anatomy may lead to impaired gallbladder motility and biliary stasis. We report the case of a 47-year-old female who presented 9 years after RYGB and cholecystectomy with acute pain in the upper abdomen because of a retroperitoneal perforation of a duodenal diverticulum. Intraoperatively, a huge enterolith was found in the diverticulum and removed via duodenotomy. We claim that the stone grew during the sober states as the bile accumulated locally, because the gall bladder has already been removed and no duodenal food passage remained. This acute and life-threatening situation was successfully managed by operation. Consequently, a duodenal diverticulum has to be considered as a possible but very rare complication after RYGB and cholecystectomy.
Roux-en-Y胃旁路术（RYGB）是全球最常开展的减肥手术之一。RYGB术后胆结石的发生率高于普通人群（30% 对比 2 - 5%），因为解剖结构改变可能导致胆囊运动功能受损和胆汁淤积。我们报告一例47岁女性病例，该患者在RYGB和胆囊切除术后9年因十二指肠憩室腹膜后穿孔出现上腹部剧痛。术中，在憩室内发现一个巨大的肠石，并通过十二指肠切开术将其取出。我们认为，由于胆囊已切除且十二指肠无食物通过，结石是在清醒状态下随着局部胆汁积聚而生长的。这种急性且危及生命的情况通过手术成功处理。因此，十二指肠憩室必须被视为RYGB和胆囊切除术后一种可能但非常罕见的并发症。
