Background

The 30-year-old female patient had a history of smoking, reflux, and obesity treated with sleeve gastrectomy with hiatal hernia repair and Toupet fundoplication. Although she sustained 90 pound weight loss postoperatively, she had liquid and food intolerance requiring revision to gastric bypass about 1.5 years after her sleeve. A month after her bypass, she had internal hernia and umbilical hernia repair. She did well for several months, but suffered from many respiratory illnesses due to longstanding asthma and history of smoking. Recently, she was admitted with parainfluenza, and treated with high dose IV steroids for 9 days, followed by PO steroids for another 11 days. It was unclear if the treating doctors understood her contraindication for steroids. Once discharged home and improved from a respiratory standpoint, she suffered severe worsening nausea, vomiting and food intolerance and was admitted to our emergency room with intolerable pain. Her workup revealed a large contained perforation of the gastrojejunal anastomosis, likely from her recent steroid use. This video demonstrates the emergent robotic surgical resection and reconstruction of her remaining stomach and roux limb, with creation of a new gastrojejunal anastomosis and specimen resection. We also review her uneventful postoperative course.