A Case of Severe Reflux Esophagitis After Total Gastrectomy Reconstruction in Billroth–II Resolved by a Simple Reoperation

Abstract

Postoperative reflux esophagitis and dumping syndrome are well known to follow total gastrectomy. We report a case of severe reflux esophagitis developing in a 73–year–old man after total gastrectomy with Billroth–II (B–II) reconstruction. He was treated by partially resecting the afferent loop and converting to Roux–Y reconstruction. Remnant total gastrectomy with B–II reconstruction was done elsewhere in September 2005 for residual stomach cancer after gastrectomy with B–I reconstruction for a gastric ulcer. Severe reflux esophagitis developing immediately postoperatively did not improve in conservative treatment. The man was referred in November 2008. Barium examination showed severe esophageal reflux due to circulation between efferent and afferent loops via the Braun anastomosis. Reconstruction converted to Roux–Y reconstruction by partially resecting the afferent loop markedly relieved postoperative esophagitis.