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ABDOMEN / GI tract general   65 / M,  Abdominal discomfort
About Author
Authors Bohyun Kim
Institution Ajou University Hospital
E-mail baboojum@naver.com
About Case
Chief complaint
or Title
Abdominal discomfort
Subspecialty ABDOMEN / GI tract general
Classification Infection, Inflammation / ulceration
Age 65 Sex M
Difficulty For resident
Modality CT, Etc
Case Figures
Click above Figure for more images.
What is your diagnosis?
Diagnosis 3

Marginal ulcer is a well-known morbid complication following pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy, and more recently, gastric bypass for bariatric surgery. Approximately 0.6-16% of gastric bypass surgery patients develop marginal ulcers, in which 1/3 of them requiring revisional surgery.


The most accepted definition of marginal ulcer is ulceration on the jejunal aspect of the gastrojejunal anastomosis. As the jejunum does not have a buffering capability against the gastric acid, it is more vulnerable to form ulcers after a chronic exposure.


In the literature, the majority of patients present with upper GI complaints as well as ulcer disease-related complications such as GI bleeding, luminal stenosis, and even perforation.


Management of marginal ulcer consists of proton pump inhibitors and surgical revision reserved for perforated or retractable ulcers.



1. Marginal ulcer after Roux-en-Y gastric bypass: what have we really learned?. El-Hayek K, et al. Surg Endosc. 2012;26(10):2789-96

2. Imaging of bariatric surgery: normal anatomy and postoperative complications. Levine MS, et al. Radiology. 2014;270(2):327-41.

3. Cross-sectional imaging, with surgical correlation, of patients presenting with complications after remote bariatric surgery without bowel obstruction. Miao TL, et al. Abdom Imaging. 2015;40(8):2945-65.
Keywords ulcer
Attachment File -

Number of Applicants : 40
Correct Answer 40
Higashi-Ohmi General Medical Center Akitoshi Inoue
서울대학교병원 Jeong Hee Yoon
Nagahama City Hospital Ryo Uemura
University of Tokyo Hospital Toshihiro Furuta
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