# Late Postoperative Hemorrhage in the Gastric Remnant Following Roux-en-Y Gastric Bypass: A Case Report

## TL;DR

A patient experienced late postoperative bleeding in the gastric remnant 18 years after Roux-en-Y gastric bypass surgery, requiring surgical intervention for diagnosis and management.

## Contribution

This case report highlights the rare occurrence of late postoperative hemorrhage and the challenges in its diagnosis and treatment.

## Key findings

- Late postoperative hemorrhage in gastric remnant is uncommon but possible years after Roux-en-Y gastric bypass.
- Traditional endoscopy and imaging may fail to diagnose the issue, necessitating laparoscopy and intraoperative endoscopy.
- Spontaneous hemostasis occurred after surgical intervention in this patient.

## Abstract

The Roux-en-Y gastric bypass (RYGB) is a commonly performed bariatric surgery option for individuals with severe obesity. Although gastrointestinal (GI) bleeds are a well-recognized complication of RYGB, it is uncommon in the late postoperative period as the surgical sites heal. It can be challenging to diagnose and manage these GI bleeds due to their isolated location and, consequently, difficult accessibility via traditional endoscopy. Various approaches have been described for the management of this complication with different treatment options, and treatment can vary based on patient risk factors and presentation. We report a case of a patient with bleeding in the gastric remnant 18 years after bypass surgery. Traditional endoscopy and other imaging options were attempted before surgical intervention, with laparoscopy and intraoperative endoscopy being warranted. The patient was discharged in stable condition after spontaneous hemostasis following a complicated hospital course.