Obesity Surgery

, Volume 28, Issue 9, pp 2976–2978 | Cite as

Lack of Diagnosis of Pneumoperitoneum in Perforated Duodenal Ulcer After RYGB: a Short Case Series and Review of the Literature

  • Jonathan ZagzagEmail author
  • Noah Avram Cohen
  • George Fielding
  • John Saunders
  • Prashant Sinha
  • Manish Parikh
  • Paresh Shah
  • Nicole Hindman
  • Christine Ren-Fielding
Brief Communication


Perforated duodenal ulcer following RYGB is an unusual clinical situation that may be a diagnostic challenge. Only 23 cases have previously been reported. We present five cases. The hallmark of visceral perforation, namely pneumoperitoneum, was not seen in three of the four cases that underwent cross sectional imaging. This is perhaps due to the altered anatomy of the RYGB that excludes air from the duodenum. Our cases had more free fluid than expected. The bariatric surgeon should not wait for free intraperitoneal air to suspect duodenal perforation after RYGB.


Gastric bypass Perforated duodenal ulcer Free air 


Compliance with Ethical Standards

Conflict of Interest

Dr. Shah has received personal fees from Olympus, Stryker, EndoEvolution, Arch Therapeutics, and Bard/Davol.

Jonathan Zagzag, Nicole Hindman, Noah Cohen, George Fielding, Christine Ren, Prashant Sinha, John Saunders, and Manish Parikh have nothing to disclose.

Informed Consent

This was a retrospective de-identified study so informed consent was not obtained.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryNYU Langone Medical CenterNew YorkUSA
  2. 2.Department of RadiologyNYU Langone Medical CenterNew YorkUSA

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