A 77-year-old man with a medical history of
hypertension,
dyslipidemia,
angina pectoris, and
internal carotid artery stenosis underwent laparoscopy-assisted distal
gastrectomy, D2
lymphadenectomy, and Billroth Ⅰ reconstruction for advanced
gastric cancer. Hematologic examination revealed severe
anemia on postoperative day 2, and abdominal CT scan detected
contrast media leakage into the remnant gastric lumen. Upper gastrointestinal endoscopy revealed mucosal
necrosis and ulceration of a large range. The patient recovered with
conservative treatment and was discharged on postoperative day 18. Endoscopic balloon dilation was required to improve anastomotic
stenosis after discharge, after which the patient received
adjuvant chemotherapy. The stomach is resistant to ischemic changes because of the microvascular networks in the stomach wall; thus, gastric remnant
necrosis after
gastrectomy is rare. However, for patients with arterial
sclerosis, such as in this case, physicians must consider the range of
gastrectomy and reconstruction methods.