Background

Gastric remnant ulceration and perforation is a rare complication but can still occur due to a variety of causes. This video demonstrates a 59-year-old female who presented with severe epigastric and left upper quadrant pain with associated nausea but no vomiting. CT scan demonstrated inflammatory changes along the gastric remnant. Due to lack of clinical improvement from nonoperative management, a diagnostic laparoscopy was performed to identify the etiology of the inflammatory changes. The diagnostic laparoscopy revealed a perforation on the anterior gastric remnant at the prior gastrotomy site where the anvil was inserted during circular stapled gastrojejunostomy. Circular stapler gastrojejunal anastomosis is still a commonly performed technique but surgeons should be aware of the material used to close the gastrotomy to avoid ulceration at this site.