A Case of Cancer in a Jejunal Pouch that Developed 13 Years after Proximal Gastrectomy and Jejunal Pouch Interposition

Abstract

A case of cancer in a jejunal pouch that developed 13 years after proximal gastrectomy and jejunal pouch interposition is reported. The patient was an 81-year-old woman who had undergone proximal gastrectomy and jejunal pouch interposition for gastric cardia cancer 13 years earlier. She underwent upper endoscopy at a nearby clinic due to anemia, and a tumorous lesion was detected inside the jejunal pouch. Well-differentiated tubular adenocarcinoma was diagnosed following examination of a biopsy specimen, and the patient was referred to our hospital for surgery. Based on a diagnosis of cancer in the jejunal pouch, total resection of the remnant stomach and jejunal pouch and Roux-en Y reconstruction were performed. An elevated tumor (colon cancer macroscopic classification, type 5), 5.0 × 4.5 cm in size, was found in the resected jejunal pouch. Histological examination showed proliferation of a mixture of papillary adenocarcinoma, moderately differentiated tubular adenocarcinoma, well-differentiated tubular adenocarcinoma, and mucinous carcinoma from the lamina propria to the subserosal layer, with papillary adenocarcinoma being the predominant type. This extremely rare case of cancer in a jejunal pouch that developed following proximal gastrectomy and jejunal pouch interposition is reported along with a review of the relevant literature.