Abstract
A 67-year-old man, who had a history of undergoing distal gastrectomy with Billroth II reconstruction for perforated duodenal ulcer 15 years previously, had complained of anorexia from 4 months earlier and lost body weight of 10 kg in about three months. He was admitted to our hospital because of recurrent bouts of vomiting and leg edema for close examination. The serum level of total protein was 4.8g/dl and the albumin level was 2.0g/dl, showing hypoproteinemia and hypoalbuminemia. An upper gastrointestinal endoscopy revealed a gastrojejunal anastomotic ulcer and a lumen continuing to the ulcer, and a contrast study confirmed a fistula to the transvers colon. The preoperative diagnosis was gastrojejunocolic fistula due to the anastomotic ulcer. Partial resection of the gastrojejunostomy and the transvers colon including the fistula with Roux-en-Y reconstruction was performed. Surgical site infection occurred after the operation but subsided, and he was discharged on the 34th postoperative day. It is necessary to consider gasrtojejunal fistula in differential diagnosis when patients who have undergone a gastrectomy for gastroduodenal ulcer suffer from such symptoms as significant weight loss or malnutrition.
