{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:55Z","timestamp":1784557075214,"version":"3.55.0"},"reference-count":6,"publisher":"Bioscientifica","issue":"3","license":[{"start":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T00:00:00Z","timestamp":1719792000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures in bariatric surgery.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\n                          The pathophysiology of this perforation is not clear, but several mechanisms have been proposed.\n                          <jats:italic>Helicobacter pylori<\/jats:italic>\n                          has been implicated.\n                        <\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Clinicians should be aware and have a low threshold for diagnostic laparoscopy for a patient who has acute abdominal pain after RYGB, despite negative diagnostic measures.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-24-0049","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T08:37:33Z","timestamp":1721032653000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":2,"title":["Perforated duodenal ulcer after Roux-en-Y gastric bypass: an unusual complication"],"prefix":"10.1530","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1654-8954","authenticated-orcid":true,"given":"Ana","family":"Munhoz","sequence":"first","affiliation":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio - ULSSA, Porto, Portugal"},{"name":"Department of Digestive and Extra-Digestive Surgery, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e1udia","family":"Paiva","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio - ULSSA, Porto, Portugal"},{"name":"Department of Digestive and Extra-Digestive Surgery, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio - ULSSA, Porto, Portugal"},{"name":"Department of Digestive and Extra-Digestive Surgery, Porto, Portugal"},{"name":"Obesity Treatment Center - Unidade de Tratamento Cir\u00fargico de Obesidade (UTCO), Porto, Portugal"},{"name":"CAC ICBAS-CHP, Porto, Portugal"},{"name":"I3S, Glycobiology and Cancer Research, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Correia","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio - ULSSA, Porto, Portugal"},{"name":"Department of Digestive and Extra-Digestive Surgery, Porto, Portugal"},{"name":"Obesity Treatment Center - Unidade de Tratamento Cir\u00fargico de Obesidade (UTCO), Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rio","family":"Marcos","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio - ULSSA, Porto, Portugal"},{"name":"Department of Digestive and Extra-Digestive Surgery, Porto, Portugal"},{"name":"Obesity Treatment Center - Unidade de Tratamento Cir\u00fargico de Obesidade (UTCO), Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Santos","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio - ULSSA, Porto, Portugal"},{"name":"Department of Digestive and Extra-Digestive Surgery, Porto, Portugal"},{"name":"Obesity Treatment Center - Unidade de Tratamento Cir\u00fargico de Obesidade (UTCO), Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Soares","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio - ULSSA, Porto, Portugal"},{"name":"Department of Digestive and Extra-Digestive Surgery, Porto, Portugal"},{"name":"Obesity Treatment Center - Unidade de Tratamento Cir\u00fargico de Obesidade (UTCO), Porto, Portugal"},{"name":"CAC ICBAS-CHP, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Gastroenterology and Hepatology","first-page":"526","article-title":"Gastrointestinal complications after bariatric surgery","volume":"11","author":"Ma","year":"2015","unstructured":"Ma IT & Madura JAII. 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(https:\/\/doi.org\/10.17533\/udea.iatreia.113)"},{"key":"bib4","series-title":"International Journal of Medical Research Professionals","first-page":"292","article-title":"Perforated duodenal ulcer following Roux-en-Y gastric bypass (RYGB): case report and literature review","volume":"3","author":"Alotbi","year":"2017","unstructured":"Alotbi RAllam HMAlmaghrabi AHGhazi AA & Alzahrani AG. Perforated duodenal ulcer following Roux-en-Y gastric bypass (RYGB): case report and literature review. International Journal of Medical Research Professionals20173292\u2013294. (https:\/\/doi.org\/10.21276\/ijmrp.2017.3.6.058)"},{"key":"bib5","series-title":"Case Reports in Surgery","first-page":"1","article-title":"Diagnosis and management of perforated duodenal ulcers following Roux-en-Y gastric bypass: a report of two cases and a review of the literature","volume":"2015","author":"Iskandar","year":"2015","unstructured":"Iskandar MEChory FMGoodman ER & Surick BG. Diagnosis and management of perforated duodenal ulcers following Roux-en-Y gastric bypass: a report of two cases and a review of the literature. Case Reports in Surgery201520151\u20134 (https:\/\/doi.org\/10.1155\/2015\/353468)."},{"key":"bib6","series-title":"Obesity Surgery","first-page":"701","article-title":"An unusual complication of gastric bypass: perforated duodenal ulcer","volume":"17","author":"Mittermair","year":"2007","unstructured":"Mittermair R & Renz O. An unusual complication of gastric bypass: perforated duodenal ulcer. Obesity Surgery200717701\u2013703. (https:\/\/doi.org\/10.1007\/s11695-007-9122-2)"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2024\/3\/EDM24-0049.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2024\/3\/EDM24-0049.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2024\/3\/EDM24-0049.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:48:26Z","timestamp":1784555306000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,1]]},"references-count":6,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.1530\/edm-24-0049","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,1]]}}}