61 y o female with recent onset of nausea and vomiting

Roux-en-y gastric bypass 2 months ago due to an iatrogenic gastric perforation

History of gastric antral vascular ectasia (GAVE) syndrome

Angioectatic stripes

•Flat mucosal vascular anomalies

•Cause slow blood loss

•Usually responsive to ablative therapy

Jejunum

Duodenum

1. No esophageal stricture or dilatation

2. Mild esophageal dysmotility

3. Narrowing at the gastro-jejunal (GJ) junction

4. Delayed emptying of the gastric pouch

Motility disorder in the Roux limb due to the rearrangement of the small bowel

Symptoms:Postprandial abdominal painNauseaBloating

Treatment:HydrationMedications: Antiemetics and prokinetic agents