A Case of Bleeding from the Site of Jejuno-Jenunostomy After Reconstruction for Gastric Cancer, Diagnosed by Scintigraphy

Abstract

We report a case that an attempt of conservative therapy for controlling the bleeding from the site of jejuno-jenunostomy after Roux-en-Y reconstruction for gastric cancer operation did not work efficiently and scintigram for gastrointestinal bleeding successfully identified the bleeding site. A 60-year-old man underwent total gastrectomy for gastric cancer in January 2010. The operation included Roux-en-Y reconstruction and D2 lymph node dissection. He was discharged on the 11^th postoperative day. On the 20^th postoperative day, he started to dine out and developed lightheadedness and had tarry stool. Under the suspicion of gastrointestinal hemorrhage, he was hospitalized again on the 25^th postoperative day. Upper endoscopy and colonoscopy did not show any apparent bleeding point. So, he started to take meal (rice gruel) on the 4^th day of hospitalization. On the 6^th day, however, massive hematemesis and melena appeared with loss of consciousness after ingestion of breakfast. Ganstrointestinal scintigraphy suggested anastomotic site hemorrhage so that upper endoscopy was performed. The bleeding point was localized at the jejuno-jejunostomy site and successfully controlled.