Abstract
A 62-year-old man, who had a medical history of a total gastrectomy with distal pancreatectomy and splectomy for advanced gastric cancer, came to local hospital complaining of abdominal pain. The abdominal computed tomography revealed dilated afferent loop, and he was referred our hospital. From the result of double-ballon enteroscopy and fluorodeoxyglucose positron emission tomography (FDG-PET), afferent loop invagination as a result of malignant tumor was suspected. He also had severe hypoalbuminemia due to nephrotic syndrome and malnutrition. Because the invagination was treated by double-ballon enteroscopy, we chose elective operation. At the operation, the tumor existed in the afferent loop, 20cm from Treitz ligament, 30cm from the jejuno-jejunostomy. The tumor was reseted by functional end to end anastomosis using liner stapler having 10cm surgical margin. Three month after operation, the patient was referred to previous hospital without improvement of hypoalbuminemia. The pathological diagnosis was small intestinal cancer. Afferent loop invagination induced by small intestinal cancer developed after total gastrectmy is extremely rare condition, and this is the first case report.
