A Case of Successful Reoperation for Severe Reflux Esophagitis after Total Gastrectomy

Abstract

A 57-year-old man who had undergone total gastrectomy followed by Roux-en-Y reconstruction for gastric cancer (pT2 pN0) complained of severe nausea and heartburn after the surgery. He had malnutrition and weight loss (15 kg in 5 months). Medication was not effective and his body weight varied around 38 kg. Gastrointestinal endoscopy revealed severe reflux esophagitis (Los Angeles Classification : Grade D), and bile reflux was observed 72.6%, predominantly in supine position with 24-hour bilirubin monitoring. The length between the esophagojejunostomy and jejunojejunostomy was found to be short (30 cm) on upper gastrointestinal radiography ; this was considered to be the cause of severe reflux esophagitis. Reoperation was performed ; the jejunojejunostomy was divided and the oral jejunum anastomosed to the jejunum 90 cm distal to the esophagojejunostomy. After the reoperation, heartburn subsided and gastrointestinal endoscopy showed no reflux esophagitis. Twenty-four-hour bilirubin monitoring showed no bile reflux. His body weight increased to 65 kg 1 year after the reoperation. Esophageal 24-hour bilirubin monitoring was useful to objectively evaluate duodenal fluid reflux and prompt appropriate treatment for reflux esophagitis after total gastrectomy.