A114 AN UNUSUAL CASE OF BLOW-OUT PERFORATION OF A DEFUNCTIONED STOMACH POST ROUX-EN-Y GASTRIC BYPASS DUE TO CROHN’S DISEASE
Bibliographic record
Abstract
Inflammatory bowel disease (IBD) has been reported after bariatric surgery. Three previous cases were reported with stricturing at the gastrojejunostomy but there has been no prior case with stricturing causing gastric outlet obstruction and blow-out perforation of the defunctioned stomach To present a rare case of Crohn’s disease presenting as recurrent stricturing post Roux-en-Y gastric bypassresulting in a blow-out perforation of the defunctioned stomach. A 55 year-old female who underwent RouxenY gastric bypass surgery 20 years ago presented with recurrent stricturing of the gastrojejunostomy and ulceration of the Roux limb felt to be secondary to local ischemia, eventually requiring surgical reconstruction. Shortly after, she presented with acute abdominal pain and was diagnosed with a blow-out perforation of the defunctioned stomach, requiring surgical repair and insertion of a venting G tube. She underwent antegrade double balloon enteroscopy, which revealed recurrent ulceration and stricturing of the gastrojejunostomy, a normal Roux limb and common channel, and stricturing at the duodenal side of the pylorus. Percutaneous endoscopy through the gastrostomy was performed and revealed a normal stomach. Biopsies of the gastrojejunostomy revealed a mixed chronic inflammatory infiltrate in the laminal propria, pseudo-pyloric metaplasia, branched crypts, and mild villous blunting. A CT angiogram demonsrtated widely patent Celiac and superior mesenteric arteries. A diagnosis of Crohn’s disease was suspected and the patient was treated with a course of prednisone. Repeat EGD showed complete resolution of ulceration at the gastrojejunostomy although her nausea and vomiting recurred when the steroids were tapered. Her prednisone was restarted and she was started on ustekinumab. Recurrent stricturing and ulceration after Roux-en- Y gastric-bypass should raise the suspicion for Crohn’s disease. Early recognition and treatment of inflammation will minimize the morbidity of the disease. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".