Ultrasound-Guided Percutaneous Gastrostomy for Decompression of the Obstructed Excluded Stomach Following Roux-en-Y Gastric Bypass: A Case Report.

Access to the excluded stomach following Roux-en-Y gastric bypass (RYGB) can be technically challenging because of altered postoperative anatomy. We present the case of a 45-year-old woman with a history of RYGB and subsequent surgery for small bowel ischemia secondary to an internal hernia who developed marked distension of the excluded stomach, consistent with obstruction at the duodenojejunal anastomosis. Pre-procedural computed tomography (CT) demonstrated severe distension of the gastric remnant and was used to assess its relationship to adjacent bowel loops and identify a safe percutaneous access route. The patient underwent ultrasound-guided percutaneous gastrostomy in the operating theater under general anesthesia. Following gastropexy, guidewire placement, and tract dilation, an 18-Fr gastrostomy tube was successfully inserted, resulting in immediate decompression with aspiration of approximately 2 L of gastric contents. At the two-month follow-up, the patient had experienced significant clinical improvement, and repeat CT demonstrated resolution of the obstruction. This case illustrates that ultrasound-guided decompressive gastrostomy may represent a useful therapeutic option in carefully selected patients with complex postsurgical anatomy when the excluded stomach is distended and sonographically accessible.