Clin Endosc.  2018 May;51(3):289-293. 10.5946/ce.2017.099.

Ischemic Necrosis of the Gastric Remnant without Splenic Infarction Following Subtotal Gastrectomy

• Park HH
• Lee HS
• Kim JS
• Kang SH
• Moon HS
• Sung JK
• Jeong HY
• Sul JY

• KMID: 2414872
• DOI: http://doi.org/10.5946/ce.2017.099

Abstract

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.

Keyword

Endoscopy; Ischemia; Subtotal gastrectomy

MeSH Terms

Endoscopy
Gastrectomy*
Gastric Stump*
Humans
Ischemia
Mortality
Necrosis*
Risk Factors
Splenic Infarction*
Stomach
Vascular Diseases

Figure

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  Fig. 1. (A, B) Endoscopy showing an irregular deep ulcer with an elevated thick mucosal fold at the lesser curvature of the antrum with an invasion into the pyloric ring.

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  Fig. 2. (A, B) Abdominal computed tomography showing focal circumferential wall thickening of the prepyloric antrum (arrow).

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  Fig. 3. (A, B) Abdominal computed tomography showing severe edematous wall thickening with poor mucosal enhancement of the remnant stomach (arrow).

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  Fig. 4. (A, B) Endoscopy showing a discolored necrotic mucosa of the gastric remnant with large and confluent ulcerations.

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  Fig. 5. Macroscopic findings of the necrotic gastric remnant.

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