Abstract
A case with stomal ulcer near afferent loop developing after partial gastrectomy (Billroth II) is reported. A 68-year-old male with abdominal pain and hematemesis was admitted to our hospital. Endoscopic examination on admission revealed massive fresh blood in the gastric remnant and duodenum, but did not reveal the distinct point of bleeding. A repeated examination 4 days later showed shallow ulceration and some erosion in the stoma near the afferent loop, and these lesions were assumed to be the source of the bleeding. Hyperacidity of gastric juice, stasis of bile and pancreatic juice in the afferent loop, decreased acid-neutralizing capacity of pancreatic juice, and change of acid composition in the bile were ruled out by functional and morphological examinations. Only the slight arteriosclerotic change was suggested on abdominal angiography. It was thus assumed that the ulcer in our case was induced by alcohol toxicity in the duodenal mucosa based on the disturbance of microcirculation due to arteriosclerosis.
