# Emergency Roux-en-Y Biliary Bypass and Duodenal Exclusion for Perforated Duodenal Ulcer

## TL;DR

This paper presents a case of emergency surgery for a perforated duodenal ulcer involving the bile duct, using a Roux-en-Y bypass and duodenal exclusion.

## Contribution

The paper introduces an emergency Roux-en-Y biliary bypass with duodenal exclusion as a salvage option for complex perforated duodenal ulcers.

## Key findings

- The procedure was used in a high-risk patient with comorbidities and resulted in an intact reconstruction at one month.
- The patient developed postoperative complications including bile leak, pneumonia, malnutrition, and a marginal ulcer.
- The technique is viable but associated with high morbidity.

## Abstract

Perforated duodenal ulcers are a life-threatening surgical emergency with high morbidity and mortality; however, there is a paucity of literature describing the operative management of perforated ulcers involving the common bile duct (CBD). This manuscript describes the case of a woman in her 60s with multiple comorbidities who underwent emergency abdominal surgery for a large perforated duodenal ulcer with extension into the CBD. An intraoperative decision was made to perform a Roux-en-Y biliary bypass with duodenal exclusion and gastroenterostomy. Her immediate postoperative course was complicated by a transient bile leak and hospital-acquired pneumonia. She was discharged with lifelong proton pump inhibitor therapy and smoking cessation counseling. Although one-month follow-up imaging confirmed an intact reconstruction, she developed malnutrition and a large upper gastrointestinal bleed secondary to a marginal ulcer two months postoperatively. This technique offers a viable salvage option when conventional repair is not possible but is associated with high morbidity.