[Perforated duodenal ulcer in patient with prior gastric bypass]. / Ulcère duodénal perforé chez une patiente avec antécédent de bypass gastrique.

Duodenal ulcer perforation in patients undergoing gastric bypass surgery is a rare late complication, occurring in less than 1% of cases. It carries a high mortality risk, particularly in cases of delayed diagnosis. The challenge lies in an unspecific clinical presentation and laboratory findings, as well as a CT scan not very helpful in almost half of cases. These features may lead to the consideration of other differential diagnoses, such as pancreatitis or cholecystitis. A multidisciplinary approach in collaboration with digestive surgeons is essential to enable rapid exploratory laparoscopy in presence of diagnostic uncertainty, and appropriate therapeutic management.

La perforation de l'ulcère duodénal chez un patient ayant subi une chirurgie de bypass gastrique est une complication tardive rare, survenant dans moins de 1 % des cas. Elle présente un risque élevé de mortalité, particulièrement en cas de diagnostic retardé. Le défi réside dans une présentation clinique et des résultats biologiques peu spécifiques, ainsi qu'un scanner peu contributif dans près de la moitié des cas. Ces caractéristiques peuvent conduire à envisager d'autres diagnostics différentiels, tels que la pancréatite ou la cholécystite. Il est essentiel d'adopter une approche multidisciplinaire en collaboration avec les chirurgiens digestifs pour permettre une laparoscopie exploratrice rapide en cas d'incertitude diagnostique, ainsi qu'une prise en charge thérapeutique appropriée.

Fast-moving stars around an intermediate-mass black hole in ω Centauri.

Black holes have been found over a wide range of masses, from stellar remnants with masses of 5-150 solar masses (M☉), to those found at the centres of galaxies with M > 105M☉. However, only a few debated candidate black holes exist between 150M☉ and 105M☉. Determining the population of these intermediate-mass black holes is an important step towards understanding supermassive black hole formation in the early universe1,2. Several studies have claimed the detection of a central black hole in ω Centauri, the most massive globular cluster of the Milky Way3-5. However, these studies have been questioned because of the possible mass contribution of stellar mass black holes, their sensitivity to the cluster centre and the lack of fast-moving stars above the escape velocity6-9. Here we report the observations of seven fast-moving stars in the central 3 arcsec (0.08 pc) of ω Centauri. The velocities of the fast-moving stars are significantly higher than the expected central escape velocity of the star cluster, so their presence can be explained only by being bound to a massive black hole. From the velocities alone, we can infer a firm lower limit of the black hole mass of about 8,200M☉, making this a good case for an intermediate-mass black hole in the local universe.