A rare complication of single anastomosis gastric bypass surgery: Perforated marginal ulcer

The single anastomosis gastric bypass (SAGB), also known as the mini gastric bypass, is a modification of the loop gastric bypass. The SAGB is technically easier to perform than a Roux-en-Y gastric bypass because it requires only one anastomosis. Marginal ulcer disease is a common complication of gastric bypass surgery, yet perforation of the ulcer is rare. We present a 46-year-old man who presented with chest and upper abdominal pain one year after undergoing SAGB. CT scans of the abdomen and pelvis demonstrated a number of small bowel loops with a thickened wall in the left abdomen, epigastric free abdominal air of a medium-large amount and a small amount of fluid between the intestinal loops and in the pelvis. An urgent exploratory laparoscopy revealed a perforation of a marginal ulcer. Recovery was uneventful. Our patient did not have any of the known risk factors for a marginal ulcer, nor did he have any ulcer specific symptoms prior to his admission. This case demonstrates the possible occurrence of a perforated ulcer following gastric bypass surgery, even among patients without risk factors.