Abstract
The patient, a 65-year-old male, underwent total gastrectomy and Roux-en-Y (abbreviated as R-Y in the following) reconstruction for gastric cancer at the beginning of October 2010. On visiting our hospital in late November upon an onset of right upper quadrant pain after breakfast, dilatation of the afferent loop was found by abdominal CT scan. Afferent loop syndrome due to R-Y anastomotic stenosis was suspected, and in performing endoscopy it was not possible to guide to the R-Y anastomotic site. Therefore, an endoscopist was notified in advance in order to enable the performance of an intraoperative endoscopic balloon dilation, a method of treatment that was minimally invasive for the patient, and relaparotomy was conducted.
As firm adhesions, with tortuosities, of the jejunal loop and the transverse colon to the abdominal wall were found, synechiotomy was performed during which the surgeon manually advanced an oral endoscope to the R-Y anastomotic site to perform endoscopic balloon dilation for the R-Y anastomotic stenosis. No restenosis has occurred to the present, one year and six months after the operation.
