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Purpose <p>Marginal ulcers are known complications following Roux-en-Y gastric bypass (RYGB), often managed medically. However, refractory ulcers can cause significant morbidity and, rarely, extension into adjacent organs. This report describes a rare case of marginal ulceration eroding into the pancreas with gastrogastric fistula formation, managed by laparoscopic reversal of RYGB.</p> Case presentation <p>A 62-year-old male with prior sleeve gastrectomy and subsequent RYGB for severe reflux presented with persistent epigastric pain, oral intolerance, and 50-pound weight loss. Endoscopy revealed a circumferential marginal ulcer causing gastric outlet obstruction. Nutritional support with jejunostomy and total parenteral nutrition (TPN) failed. Repeat imaging demonstrated a gastrogastric fistula. Surgical exploration confirmed ulcer erosion into the pancreas. A laparoscopic reversal of the RYGB was performed. Postoperative recovery was complicated by high drain output (normal lipase). The patient recovered well, resumed full oral intake, gained 20 pounds, and was weaned off TPN.</p> Conclusion <p>Laparoscopic reversal of RYGB is a viable treatment option in patients with severe, refractory marginal ulcers and associated visceral involvement. Early recognition and multidisciplinary management are key to favorable outcomes.</p>

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Laparoscopic reversal of Roux-en-Y gastric bypass for chronic marginal ulcer eroding into the pancreas with gastrogastric fistula

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月11日

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  • Salma Khan,
  • Nolberto Jaramillo,
  • Naveed Haroon,
  • Rachael Barnes,
  • Dosuk Yoon,
  • Ashutosh Kaul

摘要

Purpose

Marginal ulcers are known complications following Roux-en-Y gastric bypass (RYGB), often managed medically. However, refractory ulcers can cause significant morbidity and, rarely, extension into adjacent organs. This report describes a rare case of marginal ulceration eroding into the pancreas with gastrogastric fistula formation, managed by laparoscopic reversal of RYGB.

Case presentation

A 62-year-old male with prior sleeve gastrectomy and subsequent RYGB for severe reflux presented with persistent epigastric pain, oral intolerance, and 50-pound weight loss. Endoscopy revealed a circumferential marginal ulcer causing gastric outlet obstruction. Nutritional support with jejunostomy and total parenteral nutrition (TPN) failed. Repeat imaging demonstrated a gastrogastric fistula. Surgical exploration confirmed ulcer erosion into the pancreas. A laparoscopic reversal of the RYGB was performed. Postoperative recovery was complicated by high drain output (normal lipase). The patient recovered well, resumed full oral intake, gained 20 pounds, and was weaned off TPN.

Conclusion

Laparoscopic reversal of RYGB is a viable treatment option in patients with severe, refractory marginal ulcers and associated visceral involvement. Early recognition and multidisciplinary management are key to favorable outcomes.