A Case of Perforated Ulcer of the Remnant Stomach and Bleeding at the Y–limb Anastomosis Site after Laparoscopic Distal Gastrectomy and Lateral Segmentectomy of the Liver

Abstract

A 66-year-old woman suffering from hepatitis C virus related chronic hepatitis, rheumatoid arthritis, and diabetes mellitus was admitted to our hospital. She had been on oral glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs) for four years. Serum AFP levels were elevated and a complete checkup was conducted. She was diagnosed with hepatocellular carcinoma in segment 2 of the liver (T2N0M0 Stage Ⅱ) and gastric cancer at the antrum of the stomach (T1bN0M0 Stage ⅠA). She underwent laparoscopic lateral segmentectomy of the liver and distal gastrectomy with Roux-en-Y anastomosis. She developed an ulcer perforation at the anterior wall of the remnant stomach on postoperative day (POD) 19 and underwent emergency closure of ulcer under laparoscopy. Nine days after the repeat surgery, she developed bleeding from a staple line of the Y-limb, and endoscopic hemostasis using clips was performed. Next day, she developed bleeding from the closure point of the end of jejunum, and endoscopic hemostasis by clips was performed again. A combination of glucocorticoids and NSAIDs may cause gastric ulcer and anastomotic bleeding after gastrectomy due to the delay of mucosal healing.