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Giant perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass
  1. Edward Wang1,
  2. Ruth Blackham1,2,
  3. Jeremy Tan2,
  4. Jeffrey Hamdorf1,2
  1. 1School of Surgery, The University of Western Australia, Perth, Australia
  2. 2Hollywood Private Hospital, Western Surgical Health, Nedlands, Australia
  1. Correspondence to Dr Edward Wang, Edward.Wang{at}


Perforation of a marginal ulcer (MU) is a complication of Roux-en-Y gastric bypass that can be life-threatening. We report a case of a perforated MU that presented 7 months after surgery with several interesting points for discussion. Firstly, the presentation of the ulcer was cryptic with unreliable investigations. Secondly, the ulcer presented again even after anastomotic revision surgery. Finally, the ulcer and the sepsis associated with perforation presented after months of poor nutritional intake with profound hypoalbuminaemia. Perforated MUs causing malnutrition pose clinicians with the difficult decision of which operation to offer; patch repair, revision of the anastomosis or reversal surgery. This case illustrates that primary reversal surgery for a perforated recurrent MU may be the most appropriate surgical management in this clinical situation.

  • Gastrointestinal surgery
  • General surgery
  • Bariatric Surgery
  • Roux-en-y Gastric Bypass
  • Marginal Ulcer

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  • Contributors EW wrote the case report.

    RB assisted with writing the report.

    JT proof-read the report.

    JH oversaw the writing of the report, critiqued the report and assisted with the discussion.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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