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.

Reference

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.