A non-healing ulcer after Roux-en-Y gastric bypass may indicate which condition?

A non-healing ulcer after Roux-en-Y gastric bypass is most commonly associated with the development of a gastro-gastric fistula. A gastro-gastric fistula occurs when there is an abnormal connection between the gastric pouch and the remnant stomach, which can lead to the persistence of gastric acid in the pouch and cause ulceration.

This condition can arise due to the mechanical stress and alterations in anatomy that occur during the surgical procedure, which can compromise the integrity of the pouch and lead to complications. When a fistula is present, the normal barriers to reflux are disrupted, making it easier for acid and other gastric contents to irritate the lining of the pouch, resulting in a non-healing ulcer.

Recognizing a gastro-gastric fistula as a cause of ulcer formation is critical, as it requires specific management strategies that differ from other gastrointestinal complications. Early identification and intervention can help prevent further complications and promote healing.