Differential Diagnosis for Epigastric Pain after Roux-en-Y
- Single most likely diagnosis:
- Gastrogastric fistula: This condition is a known complication of Roux-en-Y gastric bypass surgery, where a fistula forms between the stomach pouch and the remnant stomach, leading to epigastric pain, among other symptoms.
- Other Likely diagnoses:
- Marginal ulcer: Ulcers at the margin of the gastric pouch or the anastomosis site can cause epigastric pain and are a common issue post-Roux-en-Y surgery.
- Anastomotic stricture: Narrowing of the anastomosis site can lead to obstructive symptoms and pain.
- Gastritis: Inflammation of the stomach lining, which can be exacerbated by the altered anatomy post-surgery.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Bowel obstruction: Although less common, obstruction of the bowel at the anastomosis site or due to adhesions can lead to severe consequences if not promptly addressed.
- Leaks: Anastomotic leaks are a serious complication that can present with epigastric pain and require immediate intervention.
- Hemorrhage: Bleeding from the anastomosis site or from ulcers can be life-threatening.
- Rare diagnoses:
- Intussusception: A condition where a part of the intestine telescopes into another part, which can cause obstruction and pain.
- Chronic mesenteric ischemia: Reduced blood flow to the intestines, which can cause abdominal pain, including epigastric pain, though it's less common post-Roux-en-Y.
- Bezoar: A mass of food or other material that can obstruct the stomach or small intestine, potentially causing pain.