[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-458651-105":59,"doc-detail-458651-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","ulcer-perforation-on-excluded-stomach-following-gastric-bypass-surgery-a-case-report-of-atypical-presentation-without-pneumoperitoneum","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 for morbid obesity but may cause rare complications in the excluded stomach. Ulcers in this defunctionalized segment are uncommon yet clinically dangerous because they can perforate and present atypically. This case report focuses on a 41-year-old patient with gastric perforation lacking the typical diagnostic marker of pneumoperitoneum, emphasizing comprehensive evaluation, imaging, and a low threshold for surgical management post-bariatric surgery.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ulcer-perforation-on-excluded-stomach-following-gastric-bypass-surgery-a-case-report-of-atypical-presentation-without-pneumoperitoneum/458651/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ulcer-perforation-on-excluded-stomach-following-gastric-bypass-surgery-a-case-report-of-atypical-presentation-without-pneumoperitoneum/458651.png","ImageObject",300,407,{"name":92,"@type":93},"Mimi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What complication does this case report describe after Roux-en-Y gastric bypass?","Question",{"text":112,"@type":113},"It describes ulcer perforation in the excluded stomach following gastric bypass surgery, with an atypical presentation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why can the excluded stomach ulcer be difficult to diagnose?",{"text":117,"@type":113},"The excluded segment is bypassed from normal flow and endoscopic access is difficult, which can delay recognition of ulcers or perforations.",{"name":119,"@type":110,"acceptedAnswer":120},"What is atypical about this patient’s diagnostic presentation?",{"text":121,"@type":113},"The patient had gastric perforation without pneumoperitoneum, a typical diagnostic marker indicating free air in the abdomen.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},458651,1790753976,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":143,"preview_page_count":4},2336477974920,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 11/22/2025  \nReview ended 12/04/2025  \nPublished 12/09/2025  \n© Copyright 2025  \nGonçalves et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98785  \nOpen Access Case Report  \nUlcer Perforation on Excluded Stomach Following Gastric Bypass Surgery: A Case Report of Atypical Presentation Without Pneumoperitoneum  \nNuno Gonçalves 1, 2, José Pedro Pinto 3, Ana Ribeiro 2, Fernando Manso 4, Joaquim M. Costa Pereira 5  \n1. School of Medicine, University of Minho, Braga, PRT 2. General Surgery Department, Hospital de Braga, Braga, PRT 3. General Surgery, Unidade Local de Saúde de Braga, Braga, PRT 4. Bariatric Surgery, Unidade Local de Saúde de Braga, Braga, PRT 5. Colorectal Surgery, Unidade Local de Saúde de Braga, Braga, PRT  \nCorresponding author: Nuno Gonçalves, [nunogsilvagoncalves@gmail.com](nunogsilvagoncalves@gmail.com)  \nAbstract  \nRoux-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-yearold 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.  \nCategories: General Surgery  \nKeywords: bariatric surgery complications, gastric bypass surgery, gastric ulcer perforation, minimally invasive surgery, pneumoperitoneum  \nIntroduction  \nBariatric surgery has become increasingly common in the management of morbid obesity, providing significant weight loss and improvement in obesity-related comorbidities [1-3]. However, as the population of bariatric surgery patients grows, so does the recognition of rare but serious complications, including gastric perforation. The incidence of gastric perforation after gastric bypass surgery, particularly at the anastomosis between the gastric pouch and the jejunum, has been reported to be less than 5% . Ulcers in the excluded stomach, also known as remnant gastric ulcers, represent a rare but critical complication following Roux-en-Y gastric bypass (RYGB) surgery. In RYGB, the gastric remnant and duodenum are excluded from the alimentary tract, making endoscopic access to this segment difficult and contributing to delays in diagnosing ulcers or perforations in the defunctionalized pouch. Unlike marginal ulcers, which occur at the gastrojejunostomy, excluded stomach ulcers develop in the remnant gastric pouch that has been bypassed and no longer participates in food digestion. These ulcers pose a considerable risk of morbidity and  \nmortality if not diagnosed promptly and accurately [4-6].  \nThe pathophysiology of these ulcers is complex and multifactorial, involving several predisposing factors such as Helicobacter pylori infection, smoking, the use of non-steroidal anti-inflammatory drugs (NSAIDs), and the size of the gastric pouch. Although the excluded stomach is bypassed from the normal alimentary flow, acid secretion persists because the parietal cells remain physiologically active. In the absence of food intake through this segment, gastric secretions are not buffered, creating a more acidic environment that can predispose to mucosal injury. Additionally, stasis of gastric fluids within the defunctionalized pouch may contribute to localized irritation and chemical inflammation. Altered vagal stimulation af","cbCaieTlrisZs0rF","https://ap.wps.com/l/cbCaieTlrisZs0rF","pdf",1720058,"English","# Introduction\n## Background on bariatric surgery and rare complications\n## Excluded stomach ulcers and clinical implications\n# Pathophysiology\n## Predisposing factors and mechanisms\n# Clinical presentation and diagnosis\n## Classic triad and limits of pneumoperitoneum","[{\"question\":\"What complication does this case report describe after Roux-en-Y gastric bypass?\",\"answer\":\"It describes ulcer perforation in the excluded stomach following gastric bypass surgery, with an atypical presentation.\"},{\"question\":\"Why can the excluded stomach ulcer be difficult to diagnose?\",\"answer\":\"The excluded segment is bypassed from normal flow and endoscopic access is difficult, which can delay recognition of ulcers or perforations.\"},{\"question\":\"What is atypical about this patient’s diagnostic presentation?\",\"answer\":\"The patient had gastric perforation without pneumoperitoneum, a typical diagnostic marker indicating free air in the abdomen.\"}]","Ulcer Perforation on Excluded Stomach Following Gastric Bypass Surgery - A Case Report of Atypical Presentation Without Pneumoperitoneum | PDF",13]