A case of successful metallic stent placement for malignant gastric outlet obstruction after Billroth II reconstruction

Abstract

A 70-years-old woman in her seventies─who had received wide resection of the stomach with Billroth-II reconstruction for peptic ulcer perforation approximately 40 years previously─was referred to our hospital for epigastralgia. Gastrointestinal tract examination revealed remnant gastric cancer, and peritoneal dissemination was diagnosed at exploratory laparotomy. The patient developed gastric outlet obstruction after poor response to chemotherapy and a self-expandable metallic duodenal stent was placed. Upper gastrointestinal radiography with a flexible cannulation device was necessary for identification of the afferent and efferent loops. An uncovered metallic duodenal stent was inserted into the efferent loop to maintain flow of duodenal fluid from the afferent to efferent loop. Placement of the stent improved the patient’s oral intake and quality of life. She was capable of oral intake until just prior to death from progressive disease. We successfully managed malignant gastric outlet obstruction after Billroth-II reconstruction with SEMS placement using a flexible cholangiography catheter.