Abstract
The patient was a woman in her seventies with a history of pancreaticoduodenectomy for bile duct cancer. the patient had been given oral warfarin potassium daily due to postoperative deep vein thrombosis. In March 2010, the patient was found to have rectal cancer and received abdominoperineal resection. After the operation, bleeding from the stoma was identified and sever anemia was noted. The severe anemia was caused by hemorrhagic ulcer at the jejunal side of the gastrojejunal anastomosis. The ulcer healed by intensive treatment with proton pump inhibitor (PPI). In June 2010, however, rebleeding occurred and the patient was treated with bedtime administration of histamine H2-receptor antagonist in addition to PPI. After these treatments, bleeding stopped. Rebleeding occurred again in early August 2010, and we judged further conservative management was in appropriate. We selected thoracoscopic truncal vagotomy as a surgical procedure. After the operation, gastrointestinal motility was decreased due to the truncal vagotmy and the gastric outlet was obstructed. This state was successfully treated by prokinetic drugs. The patient remains free from recurrence, and has been followed with PPI treatment on an outpatient basis. Intractable anastomotic ulcer is rarely treated by thoracoscopic truncal vagotomy. We herein report this case with a review of the relevant literature.
