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DOI: 10.1055/s-0045-1806365
Endoscopic management of a rare bleeding case after total gastrectomy and Roux-en-Y esophago-jejunal anastomosis
Aims Total gastrectomy and Roux-en-Y esophago-jejunal anastomosis is a common surgical procedure performed for the treatment of gastric cancer and other pathologies requiring gastric resection. While the procedure is generally safe, it carries a risk of various complications, including bleeding, stricture formation, anastomotic leaks and malabsorption [1] [2] [3].
Methods A 65-year-old male was presented in the emergency room (ER) in the 14-day post-surgery with massive GI bleeding, manifested with hematochezia. Total gastrectomy with RY esophago-jejunal was performed 2 weeks before the presentation in ER for gastric cancer.
Results The patient was admitted in ICU because of the hypovolemic shock, and resuscitation therapy was started. Being in the second week post op, esophago-jejunoscopy with low air insufflation was performed for evaluation of both anastomoses, which were normal. In jejuno-jejunal anastomosis bleeding clots were seen. After difficult intubation of the duodenal limb due to anastomotic angulation, a shallow ulcer with a bleeding vessel was seen in the posterior part of the duodenal limb, which was safely treated with over the scope clip. The patient was discharged in the 5-day after the procedure.
Conclusions This case report presents an uncommon complication of total gastrectomy and Roux-en-Y esophago-jejunal anastomosis. Exploring the duodenal limb and treating the lesion is difficult due to anastomotic angulation. Over the scope clip is a feasible and safe treatment method for such situations.
Publication History
Article published online:
27 March 2025
© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.
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References
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