Pavel Skok

Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidence of bariatric operations and coherently possible complications after such procedures, which modify patients anatomy and physiology.

Mallory-Weiss syndrome: review of a thirteen-year period.

BACKGROUND Acute upper gastrointestinal hemorrhage is a frequent problem of emergency medicine.Mallory-Weiss syndrome, a laceration at the esophagogastric junction, is an uncommonsource of acute upper gastrointestinal hemorrhage. The purpose of the study was toevaluate the incidence of Mallory-Weiss tear and to assess the efficiency of endoscopic andsupportive treatment in a prospective, cohort study.Patients and The study includes patients with emergency endoscopy due to acute upper gastrointestinalmethods hemorrhage between January 1, 1994 and December 31, 2006. RESULTS 7921 patients were investigated: 3010 female (38 %) and 4911 male (62 %), their averageage was 59.5 years, SD ± 17.3, with a 1–106 year span. In 228 patients (2.9 %, 165 male,av. age 52 years, SD ± 17.1, range 7–90 years and 63 female, av. age 58.8 years, SD ± 19.2years, range 20–94 years) a Mallory-Weiss tear was found. In 136 patients (59.5 %)emergency endoscopy revealed signs of acute or traces of previous hemorrhage. Differentmethods of endoscopic hemostasis were carried out in 105 cases (46 %), hemostasis wassuccessful in 102 patients (97 %). The total mortality of our patients was 7.8 % (18/228patients), the majority of them died due to concommitant diseases and complicationsduring treatment. CONCLUSIONS Urgent endoscopy with different hemostatic procedures and modern supportive treatmenthave significantly improved the outcome of patients with these source of upper gastrointestinal hemorrhage