2025 Volume 58 Issue 8 Pages 441-450
Diagnosis of duodenal diverticulum is challenging during preoperative surveillance for remnant gastric cancer. Here, we present a patient with a duodenal diverticulum with a calculus that perforated soon after curative surgery for remnant gastric cancer. The patient was a 73-year-old male who underwent distal gastrectomy with Billroth II reconstruction for gastric cancer at the age of 34. He was diagnosed with anemia in a family medicine clinic and underwent esophagogastroduodenoscopy. An irregular mucosa was observed in the remnant stomach. Biopsy evaluation led to diagnosis of well-differentiated adenocarcinoma of the remnant stomach. The patient was referred to our hospital and underwent completion gastrectomy. Postoperative X-ray revealed the presence of a duodenal diverticulum for the first time. On postoperative day 3, intestinal juice was noted in the drain, suggesting gastrointestinal perforation, and reoperation was conducted. A perforated duodenal diverticulum containing a calculus was identified intraoperatively. The perforation site was repaired with simple closure and the duodenal lumen was decompressed. After the second surgery, he developed sepsis and required long-term hospitalization. He was safely discharged home 95 days after the first surgery.
