Fairweather Luke D, Pham Toan D
Department of General Surgery, Western Health, Melbourne, Australia.
J Surg Case Rep. 2022 Mar 26;2022(3):rjac112. doi: 10.1093/jscr/rjac112. eCollection 2022 Mar.
We present a rare case of a jejunal ulcer perforation in the alimentary limb ~15 cm distal to the gastro-jejunal anastomosis on the background of a previous Roux-en-Y gastric bypass (RYGB) 4 months prior to presentation. Marginal ulcer is the most common cause of jejunal perforation following RYGB. However, this is usually confined to the first few centimetres, and the incidence is highest within the first month following surgery. Other risk factors include smoking and non-steroidal anti-inflammatory drug use, infection, trauma, foreign body ingestion, Crohn's disease, typhoid, tuberculosis and malignancy. This case does not possess any of these risk factors and thus represents a unique presentation. Not all jejunal ulcers will present with classical risks factors but still will need to be excluded, given their life-threatening nature. Also, the whole alimentary limb can be susceptible to ulceration; therefore, a thorough investigation of this limb is important to exclude perforation.
我们报告了一例罕见的空肠溃疡穿孔病例，该穿孔位于胃空肠吻合口远端约15厘米的消化道肠袢处，发生在出现症状前4个月进行过Roux-en-Y胃旁路术（RYGB）的背景下。边缘性溃疡是RYGB术后空肠穿孔最常见的原因。然而，这种情况通常局限于最初的几厘米，且发病率在术后第一个月内最高。其他风险因素包括吸烟、使用非甾体类抗炎药、感染、创伤、异物摄入、克罗恩病、伤寒、结核和恶性肿瘤。该病例不具备这些风险因素中的任何一项，因此代表了一种独特的表现。并非所有空肠溃疡都会表现出典型的风险因素，但鉴于其危及生命的性质，仍需排除。此外，整个消化道肠袢都可能易患溃疡；因此，对该肠袢进行全面检查对于排除穿孔很重要。
