2025 Volume 67 Issue 3 Pages 226-232
A 69-year-old man underwent laparoscopic total gastrectomy with Roux-en-Y reconstruction for gastric cancer. He was subsequently readmitted for hematemesis and hemorrhagic stool. Emergency EGD and CS failed to reveal any bleeding foci. Massive gastrointestinal bleeding recurred on hospital day 10, and EGD through the Roux-en-Y anastomosis revealed a hemorrhagic ulcer at the duodenal stump. CT and angiography revealed no evidence of pseudoaneurysm. Continued endoscopic shielding with polyglycolic acid sheets and fibrin glue improved the ulcer, and the patient was discharged on hospital day 40. Bleeding from the duodenal stump should be considered in patients with postoperative gastrointestinal bleeding after gastrectomy with Roux-en-Y reconstruction.
