Anastomotic Obstruction Leading to Blind Pouch Dilatation after Overlap Esophagojejunostomy Following Laparoscopic Total Gastrectomy

Abstract

A 68-year-old female patient underwent laparoscopic total gastrectomy, D2 lymph node dissection, and Roux-en-Y reconstruction for esophagogastric junction carcinoma. Esophagojejunostomy was performed using the overlap method with a linear stapler. From two months postoperatively, the patient presented with frequent vomiting. Upper gastrointestinal endoscopy revealed narrowing of the jejunal loop and dilatation of the blind pouch. Anastomotic obstruction due to kinking and adhesion was suspected, with the dilated blind pouch potentially worsening the obstruction. At five months postoperatively, laparoscopic resection of the blind pouch was performed. The subsequent course was favorable, and oral intake was resumed. While the overlap method is a useful technique for esophagojejunostomy with a low incidence of anastomotic stricture, this case shows that blind pouch dilatation due to anastomotic obstruction can occur and can be treated with resection of the blind pouch.