A Case of Laparoscopic Total Gastrectomy for Familial Gastric Juvenile Polyposis Syndrome with Severe Anemia and Hypoproteinemia

Abstract

A 53-year-old woman visited a previous doctor for anemia. Abdominal CT revealed prominent thickening of the stomach wall, and the patient was referred to our department for further examination. She gave a family history of total gastrectomy with a young gastric polyp. Esophagogastroduodenoscopy revealed multiple hyperplastic polyps throughout the stomach wall. We made the diagnosis of familial gastric juvenile polyposis syndrome, and observed her on an outpatient basis. However, she needed emergency hospitalization after she vomited blood and was found to have severe anemia and hypoproteinemia. She received conservative treatment for 3 days, but her general condition as well as anemia worsened. We determined that medical treatment might be inadequate, and performed temporary laparoscopic total gastrectomy and cholecystectomy. The patient was discharged on day 13 after the operation, without any perioperative complications. There are many cases of gastric juvenile polyposis syndrome with anemia and hypoproteinemia who require surgical resection and are at a high risk for developing complications such as suture failure. In general, the use of laparoscopic versus open surgery for total gastrectomy remains controversial, in terms of the risk of complications. However, with sufficient caution adopted for safe performance, total gastrectomy under laparoscopic guidance might be associated with reduced surgical risk in terms of smaller surgical wounds and less postoperative pain, and also reduced hospital stay.