[Late perforation following laparoscopic gastric bypass]

Area of Science:

• Gastroenterology
• Surgical Complications
• Bariatric Surgery

Background:

• Laparoscopic gastric bypass is a common bariatric procedure.
• While generally safe, potential complications can arise post-surgery.
• Late complications, though rare, require careful consideration.

Observation:

• Two patients presented with acute abdominal pain 4-5 months post-laparoscopic gastric bypass.
• Surgical exploration identified small bowel perforations near the distal anastomosis in both cases.

Findings:

• Case 1: Massive small bowel constipation was a likely contributing factor to perforation.
• Case 2: A kinked entero-entero anastomosis caused obstruction and biliary limb perforation.

Implications:

• Late small bowel perforations are rare but significant complications of gastric bypass.
• These cases underscore the need for vigilance in diagnosing late post-operative issues.
• Prompt recognition and surgical intervention are crucial for managing these adverse events.