Gastric Remnant Perforation Caused by Peterson's Hernia Following One Anastomosis Gastric Bypass: a Rare Complication.

introductionOne anastomosis gastric bypass (OAGB) has gained popularity over the recent years; it appears to be an effective bariatric procedure with acceptable weight loss, co-morbidity resolution, and complication rates in the short and medium term. However, it still continues to have concerns in the bariatric community due to a spectrum of potential complications. To our knowledge, there are few published cases of internal hernia, but no published reports of gastric remnant perforation following OAGB. CASE PRESENTATION: We report a case of a 32-year-old female who developed a perforation of the remnant stomach along the gastric fundus secondary to bowel obstruction 5 years after OAGB. The perforation was managed by stapled resection of the perforated fundus and closure of Peterson's space for potential hernia as a causative factor, and the patient had a smooth postoperative recovery. DISCUSSION: Early diagnosis is crucial in post bariatric emergencies with a low threshold of early intervention. Gastric remnant perforation was previously described in some reports following Roux-en-Y gastric bypass (RYGB) but not after OAGB. Etiology of perforation can be rationalized to primary gastric remnant pathology or secondary to external factors such as back pressure of mechanical/functional bowel obstruction.

conclusionPeterson's hernia and gastric remnant perforation are rare, yet serious, complications that need to be kept in mind while dealing with post-OAGB patients presenting with abdominal pain. Early diagnosis and treatment are essential for a better outcome.