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Abdominal actinomycetoma should be considered as a differential diagnosis of any abdominal wall mass for patients with known risk factors and surgery and antibiotics are the only curative treatment. Bariatric or metabolic surgery is an emerging surgical specialty. With the increase of obesity and affiliated complications, the Roux-en-Y gastric bypass became a well-established procedure worldwide. We present the case of a 46-year-old female patient who presented herself in the emergency department with diffuse abdominal pain, 13 years after