Laparoscopic management of gastric remnant ischemia after laparoscopic distal gastrectomy with Billroth-I anastomosis-A case report.
Anastomosis
Esophagogastroduodenoscopy
Gastric remnant
Ischemia
Laparoscopic surgery
Roux-en-Y
Subtotal gastrectomy
Journal
International journal of surgery case reports
ISSN: 2210-2612
Titre abrégé: Int J Surg Case Rep
Pays: Netherlands
ID NLM: 101529872
Informations de publication
Date de publication:
2020
2020
Historique:
received:
26
09
2019
revised:
04
12
2019
accepted:
09
12
2019
pubmed:
31
12
2019
medline:
31
12
2019
entrez:
30
12
2019
Statut:
ppublish
Résumé
Gastric remnant ischemia after laparoscopic distal gastrectomy (LDG) in gastric cancer patients is a very rare but life-threatening condition, especially when accompanied by a splenic infarction or unplanned splenectomy. A 72-year-old male with no comorbid diseases was diagnosed with a well-differentiated adenocarcinoma of the lower stomach and underwent LDG with D2 lymph node dissection. However, a splenic artery injury necessitated a splenectomy intra-operatively, and delta anastomosis was performed based on a clinically viable remnant stomach. During the late post-operative period, the patient developed abdominal pain and showed increased levels of inflammatory biomarkers with hemodynamic stability. Esophagogastroduodenoscopy (EGD) showed necrotic patches over the distal part of the remnant stomach with normal anastomosis and duodenal mucosa. Progression of the necrosis was noted on follow up EGD performed 15 days post-surgery. Total laparoscopic subtotal gastrectomy with Roux-en-Y reconstruction was performed and the patient recovered uneventfully. Careful dissection of the lymph nodes over the major vessels is essential to avoid complications in gastric cancer patients requiring LDG. Moreover, major complications occurring intra-operatively may necessitate changes in the surgical plan, including re-excision of the remnant stomach or conversion to Roux-en-Y reconstruction. Careful evaluation of the clinical findings and close observation with EGD can help detect mucosal demarcation lines and ascertain the perfect timing for intervention in cases with suspected ischemia. Although gastric remnant ischemia requires emergency treatment, laparoscopic management is a feasible option when performed by an expert surgeon.
Identifiants
pubmed: 31884262
pii: S2210-2612(19)30712-6
doi: 10.1016/j.ijscr.2019.12.009
pmc: PMC6939066
pii:
doi:
Types de publication
Case Reports
Langues
eng
Pagination
265-269Informations de copyright
Copyright © 2019. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest There is no conflicts of interest to declare by authors.
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