Snapshot quiz 13/24

Published: 02/08/2013

Authors: Adefna R

This patient presented with signs of peritonitis 18 months after biliary enteric bypass for carcinoma of the pancreas, which included gastroenterostomy. There is a perforated anastomotic ulcer due to exposure of unprotected jejunum to gastric acid. The incidence is less than 5 per cent following gastroenterostomy, but is higher in patients who do not have simultaneous vagotomy.

The ulcer was closed with an omentoplasty and the patient recovered without complications. The incidence of marginal ulcer has increased because it is a complication of gastric bypass surgery for obesity. Omental patching and gastric acid blockade is acceptable treatment in a palliative setting, although resection may be required. In some patients the operation may be accomplished using a laparoscopic approach.