Perforated Diverticulum in the Afferent Loop with Enteroliths after Distal Gastrectomy Reconstruction by the Billroth-II Method —A Case Report—

Abstract

A 63-year-old man, who had undergone distal gastrectomy and Billroth-II reconstruction for a gastric ulcer at the age of 16 years, visited our hospital because of sudden abdominal pain 4 hours earlier. Abdominal CT showed extraintestinal free air and stones in the mesentery of the afferent loop and increased density of fat tissue around the stones. Perforation of the afferent loop was diagnosed, and emergency surgery was performed. A 5 cm lange diverticulum of the afferent loop was perforated by four 1 to 2 cm diameter stones. Partial resection of the afferent loop and drainage were performed. On histopathology, a pseudodiverticulum was seen, and stone analysis showed a calcium salt enterolith. The final diagnosis was perforation of a diverticulum in the afferent loop due to a true enterolith.