# Duodenal perforation in the excluded segment: twenty-five years post-Roux-en-Y gastric bypass surgery: a case report

## TL;DR

A rare case of duodenal perforation 25 years after gastric bypass surgery is reported, highlighting the importance of early surgical intervention for better outcomes.

## Contribution

This case report adds to the limited literature on long-term complications of Roux-en-Y gastric bypass, specifically duodenal perforation in the excluded segment.

## Key findings

- A 70-year-old female presented with a perforation of the biliopancreatic limb at D3, 25 years post-Roux-en-Y gastric bypass.
- Early surgical intervention is crucial for improving outcomes in such cases.
- Diagnostic delays are common, and high clinical suspicion warrants early surgical exploration.

## Abstract

Duodenal perforations after Roux-en-Y gastric bypass surgery are a rare, but potentially life-threatening complication that poses significant challenges in diagnosis and treatment due to altered anatomy and several other risk factors such as nonsteroidal anti-inflammatory drugs, alcohol, and Helicobacter pylori infection. We present a case of a 70-year-old female status post Roux-en-Y gastric bypass for weight loss 25 years ago with chief complaint of sharp stabbing abdominal pain; she was later found to have a was later found to have a perforation of the biliopancreatic limb, specifically at D3. Early surgical intervention remains crucial in these patients for improving outcomes. Clinicians should be aware of diagnostic delays reported in the literature; and early surgical exploration (i.e. laparoscopy ± conversion to exploratory laparotomy) should be considered when clinical suspicion is high.