# Ulcer Perforation on Excluded Stomach Following Gastric Bypass Surgery: A Case Report of Atypical Presentation Without Pneumoperitoneum

## TL;DR

A rare case of stomach ulcer perforation after gastric bypass surgery is reported, showing symptoms without the usual sign of air in the abdomen.

## Contribution

This case highlights an atypical presentation of gastric perforation without pneumoperitoneum after Roux-en-Y gastric bypass.

## Key findings

- A 41-year-old patient presented with gastric perforation without pneumoperitoneum after Roux-en-Y gastric bypass.
- Comprehensive evaluation confirmed the diagnosis and emphasized the need for thorough diagnostic approaches in post-bariatric patients.
- The case underscores the importance of considering rare complications and maintaining a low threshold for surgical intervention.

## Abstract

Roux-en-Y gastric bypass (RYGB) is widely used to treat morbid obesity, but it may lead to rare complications involving the excluded stomach. Ulcers in this defunctionalized segment are particularly uncommon yet clinically significant due to their potential to perforate and present atypically. Gastric perforation following RYGB is a rare but potentially fatal complication. This case report describes a 41-year-old patient who presented with gastric perforation without the typical diagnostic marker of pneumoperitoneum. Through comprehensive clinical evaluation, laboratory testing, and imaging, this report highlights the importance of thorough diagnostic approaches in post-bariatric surgery patients, emphasizing the necessity of a low threshold for surgical intervention.