A Case of Obstruction of the Elevated Jejunum at the Esophageal Hiatus after Total Gastrectomy

Abstract

The patient was a 71-year-old man who had undergone total gastrectomy, D2, Roux-en-Y reconstruction, cholecystectomy, and splenectomy for gastric cancer in 1996. Although his clinical course had remained uneventful, he presented at our hospital in November 2011 with postprandial vomiting and reduced dietary intake since January 2011. An upper gastrointestinal screening revealed significant dilation of the blind extremity of the end-to-side anastomosis and a saccular dilated elevated jejunum on the oral side of a constriction. Surgery was performed in February 2012 for the elevated jejunum at the esophageal hiatus. Intraoperatively, the esophago-jejunal anastomosis was found to be located in the mediastinum ; furthermore, the jejunal segment on the anal side of the anastomosis was constricted by the diaphragm and the segment on the oral side was dilated. We surgically attached the esophagus on the oral side of the anastomosis to the diaphragm and cut the dilated blind extremity. After the surgery, the patient reported improved oral intake. We report a case of obstruction of the elevated jejunum at the esophageal hiatus long after total gastrectomy and Roux-en-Y reconstruction.