Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report
| Autor: | Sufian Sorathia, Arash Zarrin, Steven Kaplan, Franklin E. Kasmin, Vivek Choksi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Gastrointestinal bleeding
medicine.medical_specialty Gastric bypass Gastric remnant 03 medical and health sciences 0302 clinical medicine Case report Medicine cardiovascular diseases business.industry digestive oral and skin physiology Gastrogastrostomy Gastric outlet obstruction Endoscopic ultrasound directed transgastric intervention medicine.disease digestive system diseases Surgery surgical procedures operative 030220 oncology & carcinogenesis cardiovascular system 030211 gastroenterology & hepatology business |
| Zdroj: | World Journal of Gastrointestinal Endoscopy |
| ISSN: | 1948-5190 |
| DOI: | 10.4253/wjge.v12.i9.297 |
| Popis: | BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery. Furthermore, acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously. Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach. Traditionally, this necessitates surgical intervention. Recently, however, the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management. CASE SUMMARY A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension, nausea, and melena of two days duration. His imaging illustrated a massively distended stomach. A nasogastric tube did not result in drainage of fluid or decompression of his abdomen. His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended "fluid"-filled gastric remnant. An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant. Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum. The patient underwent emergent angiography with embolization of the gastroduodenal artery. He was discharged with a stable hemoglobin level and resolution of symptoms. Healing superficial gastric ulcers were visualized on a follow-up endoscopy. Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated, and successful eradication was achieved. CONCLUSION This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound-directed transgastric intervention. |
| Databáze: | OpenAIRE |
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