Endoscopic approach to gastric remnant outlet obstruction after gastric bypass:A case report  

作　　者：Arash Zarrin Sufian Sorathia Vivek Choksi Steven Robert Kaplan Franklin Kasmin 

机构地区：[1]Department of Internal Medicine,Aventura Hospital and Medical Center,Miami,FL 33180,United States [2]Department of Gastroenterology,Aventura Hospital and Medical Center,Miami,FL 33180,United States

出　　处：《World Journal of Gastrointestinal Endoscopy》2020年第9期297-303,共7页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：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.

关 键 词：Gastrointestinal bleeding Gastric outlet obstruction Gastric remnant Endoscopic ultrasound directed transgastric intervention Gastrogastrostomy Case report 

分 类 号：R573[医药卫生—消化系统]