Abstract Background: A 27-year-old female patient was complaining of repeated vomiting with dysphagia and remarkable weight loss after 2 years post-mini gastric bypass Upper GI Endoscopy showed a marginal ulcer with stenosis at the gastro-jejunal anastomosis. Two attempts at balloon dilatation to improve the condition was done but unfortunately failed. The decision was made to reverse the gastric bypass to normal anatomy as the patient refuse the option of conversion of the MGB to RYGB. During the surgery there were severe adhesions of the posterior wall of the anastomosis to the antrum which was opened during the dissection. The decision was made to make the gastro-gastric anastomosis between the gastric pouch and the fundus of the remnant stomach. A stenosis at the mid stomach was noted intra-operatively but it was functioning during the surgery. Postoperatively the patient could not tolerate oral intake. After three days the patient improved and start to tolerate fluid orally, so she was discharged home. After one week the patient was re-admitted due to severe repeated vomiting with low grade fever. Upper GI Endoscopy showed a leak from the upper side of the anastomosis with severe narrowing at the mid stomach. A mega stent was inserted successfully, and the patient was then able to tolerate oral intake. The stent was removed after 8 weeks. The patient currently has mild to moderate reflux otherwise she is doing well.
Mustafa Ghurra (Thu,) studied this question.