Duodenal perforation in the excluded segment: twenty-five years post-Roux-en-Y gastric bypass surgery: a case report

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 <i>Helicobacter pylori</i> infection. We present a case of a 70-year-old female status post Roux-en-Y gastric bypass for weight loss 25 years 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 ± conversion to exploratory laparotomy) should be considered when clinical suspicion is high.