Ulcer Perforation on Excluded Stomach Following Gastric Bypass Surgery: A Case Report of Atypical Presentation Without Pneumoperitoneum

Roux-en-Y gastric bypass (RYGB) is widely used to treat morbid obesity, but it may lead to rare complications involving the excluded stomach. Ulcers in this defunctionalized segment are particularly uncommon yet clinically significant due to their potential to perforate and present atypically. Gastric perforation following RYGB is a rare but potentially fatal complication. This case report describes a 41-year-old patient who presented with gastric perforation without the typical diagnostic marker of pneumoperitoneum. Through comprehensive clinical evaluation, laboratory testing, and imaging, this report highlights the importance of thorough diagnostic approaches in post-bariatric surgery patients, emphasizing the necessity of a low threshold for surgical intervention.