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RYGB Staple-line Failure

71 year-old woman, BMI 65, with a history of roux-en-Y gastric bypass (RYGB) surgery for obesity in the 1980s. The nature of the roux-en-Y procedure is illustrated in the diagram at left: staples are employed to isolate a small gastric pouch from the remaider of the stomach, which becomes bypassed by creating an outlet from the gastric pouch into a loop of small intestine. In this patient, upper endoscopy revealed complete disruption of the staple line such that the entry into the previously bypassed portion of stomach was widely patent.

Left: The staple line intended to isolate the majority of the stomach has failed and is wide open, with several residual staples still embedded in mucosa.

Center: Visible to the left of the main lumen is the entry into the gastric pouch (white arrow in central image). The pouch had normal mucosa and a patent anastomosis to small bowel.

Right: Retroflexed view, looking upward from the mid-gastric body at the gastric cardia showing post-surgical change and staples. Due to the wide-angled optics, the entry into the gastric pouch is visible from the retroflexed view.

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