2025 Volume 58 Issue 1 Pages 18-25
A 75-year-old man was diagnosed with advanced gastric carcinoma in the gastric antrum by upper gastrointestinal endoscopy performed to investigate the cause of anemia. Laparoscopic distal gastrectomy with Billroth I reconstruction (delta-shaped anastomosis) was performed. On postoperative day 3, the patient showed increased levels of inflammatory biomarkers, and contrast-enhanced CT revealed poor enhancement of the gastric wall. These findings led to diagnosis of gastric remnant necrosis, and emergency subtotal gastrectomy with Roux-en-Y reconstruction was performed. During surgery, extensive necrosis was detected from the remnant gastroduodenal anastomosis to the middle gastric body from 5 cm below the terminal branch of the short gastric artery. We report this case as a rare example of gastric remnant necrosis after laparoscopic gastrectomy with Billroth I reconstruction that suggests the causes and precautions required for this condition.
