Background

One Anastomosis Gastric Bypass (OAGB) is gaining popularity as a bariatric procedure, but it faces also some complications as biliary reflux, malnutrition and high risk of anastomotic ulcers. Case Presentation. We present a case of a 68 years old man who had been operated of a OAGB in a private center. Patient had an uneventful postoperatory and presented a very good weight loss and related disease evolution. He consulted to his General Practitioner due to increased bowel movements and epigastric pain, a blood test showed some parameters of malnutrition. Before the patient was submitted to a bariatric physician, he came to the Emergency Room with sudden abdominal pain, low blood pressure and tachycardia. A CT Scan was done and a perforated anastomotic ulcer was found. After resuscitation with iv fluids and wide spectrum antibiotics, he was taken to emergency laparoscopy where the perforated ulcer was confirmed, and a purulent peritonitis was found. The patient kept stable during the surgery, a conversion into a proximal Roux-n-Y Gastric bypass with resection of the previous GJ anastomosis and the perforated ulcer was performed. The patient had a 300cm total bowel length with a TALL of only 130cm, so a previous bowel reconstruction was required.After surgery the patient did well and was discharged on POD 6 with no complications. 5 months after surgery he gained some weight, improved his nutritional parameters and restored normal bowel movements.