GASTROJEJUNAL ANASTOMOTIC ULCER PENETRATING THE RIGHT CORONARY ARTERY AFTER LOWER ESOPHAGECTOMY WITH PROXIMAL GASTRECTOMY: A CASE REPORT

Abstract

An 82-year-old man with a history of left thoracolaparotomic lower esophagectomy and proximal gastrectomy for esophageal cancer, as well as right renal cancer and bladder cancer surgery visited our hospital with hematemesis. Electrocardiography revealed inferior wall ST-segment elevation and anterior wall ST-segment depression, and he was diagnosed with ST-segment elevation myocardial infarction and upper gastrointestinal bleeding. Endoscopic hemostasis was performed prior to cardiac catheterization. Exposed blood vessels were observed on the jejunal aspect of the anastomotic segment between the interposed jejunum and the residual stomach, and hemostasis was performed. During cardiac catheterization, the right coronary artery (the 4AV branch) showed complete occlusion. Rebleeding from the site of endoscopic hemostasis was observed following attempts to widen the #4AV branch. Therefore, we concluded that the exposed blood vessels at the site of the anastomotic ulcer represented the #4AV branch. The Graftmaster stent system (2.75 × 16 mm) was inserted into the #3-#4PD branch for hemostasis.

To date, no study has reported an anastomotic ulcer penetrating the right coronary artery; we describe this rare phenomenon in this case report.