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• W2922136444 abstract "Within the United States the rise in obesity and related metabolic complications, has led to an increase in the number of bariatric surgeries over the last decade. Roux-en-Y gastric bypass( RYGB) procedure is one of the most common weight-loss procedures performed in the United States. Notwithstanding the improvement in the bariatric surgical procedures, complications do occur. In the early postoperative phase, complications can occur including; obstruction of bypassed bowel, anastomotic leak and nutritional deficiencies to list a few. In rare cases, a gastro-jejunal leakage and fistula can occur. We present a rare complication of RYGB leading to formation of a gastro-jejunal fistula formation. A 51 year old woman with history of gastric bypass in 2007 presented to clinic with worsening epigastric abdominal pain associated with nausea, and unintentional weight loss of ˜8lbs over a 2 week period. She denied vomiting, hematemesis, melena or hematochezia. Physical examination was unremarkable. Laboratory investigation revealed a normal complete blood count and basic metabolic profile. An Esophagogastroduodenoscopy( EGD) showed a small gastric pouch consistent with prior gastric bypass, erythematous mucosa at the gastro-enteric anastomosis and a fistulous opening in distal gastric pouch near the anastomosis (image). The opening into the jejunal loop was narrowed precluding intubation with an upper endoscope. Biopsies of the anastomotic site exhibited mild chronic inactive gastritis, negative for Helicobacter pylori. The patient was managed with a proton pump inhibitor(PPI) daily for 8 weeks. On follow up, she reported complete resolution of her symptoms. A follow up EGD showed healing of the fistilous tract. As reviewed in literature, spontaneous fistulization formation secondary to gastritis (peptic ulcer disease particularly) is a rare complication. Fistulaization typically affects middle aged to elderly females with risk factors; NSAID use, H. Pylori infection, postoperative stress and minimal mesenteric adipose tissue. It is our responsibility as gastroenterologists to be familiar with potential complications after bariatric surgery and management strategies. This case further validates that surgical intervention is not always required in gastroenteric fistulas and that medical therapy with appropriate follow up can be used to manage such complications.1888 Figure 1. Small gastric pouch, erythematous mucosa with a gastro-jejunal fistulous opening (left) near gastro-enteric anastomosis (right)." @default.
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• W2922136444 date "2018-10-01" @default.
• W2922136444 modified "2023-09-27" @default.
• W2922136444 title "A Case Report Identifying the Clinical Significance of Spontaneous Gastrojejunal Fistulization Related to Roux-en-Y Bypass" @default.
• W2922136444 doi "https://doi.org/10.14309/00000434-201810001-01888" @default.
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