Abstract
We report a case of small bowel malignancy arising in the jejunal limb 3 years after total gastrectomy. A 65-year-old man was diagnosed with gastric cancer (pStage Ib) and underwent total gastrectomy, splenectomy, and cholecystectomy in May 2006. Anemia and a positive fecal occult blood test result were found in July 2009. Endoscopy revealed a tumor in the jejunal limb, which was diagnosed as well-differentiated adenocarcinoma on biopsy. Partial resection of the jejunal limb was performed in September 2009. The resected specimen showed a 30×15 mm, mobile, elevated lesion. Histopathological examination showed well-differentiated adenocarcinoma located mainly in the mucosa and submucosa with vascular invasion to the subserosa. This lesion was initially considered either a new primary small bowel tumor or recurrence of the gastric cancer from 3 years previously. Primary small bowel cancer was then diagnosed after histopathological findings showed a tumor originating in the mucosa with invasion into deeper layers. It is important to consider endoscopy to investigate the jejunal limb when patients show symptoms after total gastrectomy.
