A Case of Small Bowel Obstruction Caused by Gastrolithiasis after Pylorus-preserving Gastrectomy Treated by Single-port Laparoscopic Surgery

Abstract

A 62-year-old woman had received pylorus-preserving gastrectomy for early gastric cancer. She was admitted to our hospital because of abdominal pain and nausea. Computed tomogram showed small bowel obstruction due to a low-density mass containing air bubbles, characteristic of gastrolithiasis. Although an ileus tube was inserted and dissolution of the gastrolithiasis by Coca-Cola^® was carried out, the obstruction did not improve. She underwent single-port laparoscopic surgery. The gastrolithiasis of about 40 mm diameter was blocking the small intestine at about 30 cm from the ileocolic valve, and the distended part was extracted from the abdominal cavity. An incision of the small bowel was made, and the stone was removed. Finally, the incisional site was closed. Although she had prolonged high fever postoperatively, she improved with administration of antibiotics. She was discharged 29 days after the operation. On analysis of the components of the stone, 98% of it was tannic acid, and a diagnosis of gastrolithiasis was confirmed. After pyloric-preserving gastrectomy, the frequency of gastrolithiasis is higher than that after distal gastrectomy. If gastrolithiasis remains in the stomach, endoscopic extraction, dissolution therapy by Coca·Cola^® or surgical treatment should be tried. In rare cases, gastrolithiasis could cause intestinal obstruction. Since dissolution therapy for a stone in the small intestine is rarely effective, surgical treatment should be considered at an early stage.