Postoperative non-anastomotic
stenosis of the proximal jejunum after total
gastrectomy with Roux-en-Y reconstruction is a rare complication. If endoscopic balloon dilation proves ineffective, patients need re-operation under
general anesthesia and experience a high rate of postoperative complications. Magnetic compression anastomosis is a nonsurgical procedure that can create an anastomosis similar to that obtained through surgery. We report a case in which magnetic compression anastomosis was successfully performed to avoid re-operation for non-anastomotic
stenosis of the proximal jejunum after total
gastrectomy with Roux-en-Y reconstruction.
CASE PRESENTATION: A 70-year-old woman was admitted to our hospital for treatment of non-anastomotic
stenosis of the proximal jejunum. Open total
gastrectomy and Roux-en-Y reconstruction were performed 2 years previously for advanced
gastric cancer at another hospital. She complained of
anorexia and obstructed passage of food. No recurrence of
gastric cancer was identified. Esophagogastroduodenoscopy showed circumferential membranous
stenosis of the jejunum 3 cm distal to the esophago-jejunal anastomosis. Endoscopic balloon dilation was performed three times, but proved ineffective. Magnetic compression anastomosis was planned because the
stenosis existed near the esophago-jejunal anastomosis and re-operation was a highly invasive procedure requiring intrathoracic anastomosis. Endoscopic balloon dilation preceded placement of the parent magnet on the anal side of the
stenosis. Confirming the improvement of
stenosis, the parent magnet was placed on the anal side of the
stenosis during esophagogastroduodenoscopy. The parent magnet attached to
nylon thread was fixed to the cheek to prevent magnet migration. A week after placing the parent magnet, restenosis was confirmed and the daughter magnet was placed via
nylon thread on the oral side of the
stenosis. The two magnets were adsorbed in the end-to-end direction across the
stenosis. Magnets adsorbed in the end-to-end direction moved to the anal side 11 days after placement. Wide anastomosis was confirmed by esophagogastroduodenoscopy. Endoscopic balloon dilation was regularly performed to prevent restenosis after magnetic compression anastomosis. No complications were observed postoperatively. The patient was able to eat normally and successfully reintegrated into society.
CONCLUSIONS: Magnetic compression anastomosis could be a feasible procedure to avoid surgery for non-anastomotic
stenosis of the proximal jejunum after
gastrectomy with Roux-en-Y reconstruction.