{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T21:36:24Z","timestamp":1779312984422,"version":"3.51.4"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u00a0years 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\u2009\u00b1\u2009conversion to exploratory laparotomy) should be considered when clinical suspicion is high.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf856","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T12:04:33Z","timestamp":1760097873000},"source":"Crossref","is-referenced-by-count":1,"title":["Duodenal perforation in the excluded segment: twenty-five years post-Roux-en-Y gastric bypass surgery: a case report"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6591-5190","authenticated-orcid":false,"given":"Neha","family":"Aftab","sequence":"first","affiliation":[{"name":"Department of Trauma and Acute Care Surgery, Hurley Medical Center , 1 Hurley Plaza, Flint, MI 48503 ,","place":["United States"]},{"name":"Department of Surgery, Michigan State University College of Human Medicine , 200 E 1st St, Flint, MI 48502 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara N","family":"Nesheiwat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Henry Ford Genesys Hospital , 1 Genesys Pkwy, Grand Blanc, MI 48439 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos Martinez","family":"Elizondo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Henry Ford Hospital Macomb , 19 Mile Rd, Clinton Township, MI 48038 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Trauma and Acute Care Surgery, Hurley Medical Center , 1 Hurley Plaza, Flint, MI 48503 ,","place":["United States"]},{"name":"Department of Surgery, Michigan State University College of Human Medicine , 200 E 1st St, Flint, MI 48502 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristoffer","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Trauma and Acute Care Surgery, Hurley Medical Center , 1 Hurley Plaza, Flint, MI 48503 ,","place":["United States"]},{"name":"Department of Surgery, Michigan State University College of Human Medicine , 200 E 1st St, Flint, MI 48502 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gul R","family":"Sachwani-Daswani","sequence":"additional","affiliation":[{"name":"Department of Trauma and Acute Care Surgery, Hurley Medical Center , 1 Hurley Plaza, Flint, MI 48503 ,","place":["United States"]},{"name":"Department of Surgery, Michigan State University College of Human Medicine , 200 E 1st St, Flint, MI 48502 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"2025102410324734000_ref1","doi-asserted-by":"publisher","first-page":"e35112","DOI":"10.7759\/cureus.35112","article-title":"Perforated duodenal ulcer post-Roux-en-Y gastric bypass: a case report","volume":"15","author":"Hughes","year":"2023","journal-title":"Cureus"},{"key":"2025102410324734000_ref2","doi-asserted-by":"publisher","first-page":"rjac112","DOI":"10.1093\/jscr\/rjac112","article-title":"Non-marginal jejunal ulcer perforation following Roux-en-Y gastric bypass","volume":"2022","author":"Fairweather","year":"2022","journal-title":"J Surg Case Rep"},{"key":"2025102410324734000_ref3","doi-asserted-by":"publisher","first-page":"bcr2016218829","DOI":"10.1136\/bcr-2016-218829","article-title":"Giant perforated marginal ulcer after laparoscopic Roux-en-Y gastric 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Surg"},{"key":"2025102410324734000_ref7","doi-asserted-by":"publisher","first-page":"76","DOI":"10.17476\/jmbs.2023.12.2.76","article-title":"Outcomes and adverse events after bariatric surgery: an updated systematic review and meta-analysis, 2013-2023","volume":"12","author":"Kim","year":"2023","journal-title":"J Metab Bariatr Surg"},{"key":"2025102410324734000_ref8","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1007\/s11695-020-05123-w","article-title":"Ulcer disease in the excluded segments after Roux-en-Y gastric bypass: a current review of the literature","volume":"31","author":"Plitzko","year":"2021","journal-title":"Obes Surg"},{"key":"2025102410324734000_ref9","doi-asserted-by":"publisher","first-page":"2976","DOI":"10.1007\/s11695-018-3321-x","article-title":"Lack of diagnosis of pneumoperitoneum in perforated duodenal ulcer after RYGB: a short case series and review of the literature","volume":"28","author":"Zagzag","year":"2018","journal-title":"Obes 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