Necrosis of the Gastric Remnant after Distal Gastrectomy for Gastric Carcinoma—A Case Report—

Abstract

A 70-year-old woman who was on maintenance dialysis for diabetic chronic kidney disease and had previously undergone coronary artery bypass surgery for angina was found to have submucosal infiltration of the gastric antrum suggestive of early-stage carcinoma on upper gastrointestinal endoscopy. Abdominal computed tomography (CT) showed widespread calcification of vessels including the celiac artery, splenic artery, and short gastric artery. Distal gastrectomy and Billroth I reconstruction were performed laparoscopically. Widespread necrosis of the mucosa of the gastric remnant was visible on postoperative upper gastrointestinal endoscopy. On contrast-enhanced CT, the gastric wall was poorly contrasted, and several split were visible. Necrosis of the gastric remnant was diagnosed, and the gastric remnant was removed on postoperative day 13. After the second procedure, however, duodenal stump suture failure occurred, the patient's general condition deteriorated, and she died on day 23 after the initial surgery. The widespread calcification of the splenic and short gastric arteries in this patient may have reduced perfusion to the gastric remnant, which could have been one factor that contributed to its necrosis. Necrosis of the gastric remnant is an extremely rare complication of gastrectomy, but once it develops its course is frequently critical and its early diagnosis and early second surgery are vital.