A Case of Primary Duodenal Carcinoma After Total Gastrectomy with Roux-Y Reconstruction

Kazushige Shibahara, Kaeko Oyama, Yoshihiko Arano and Masatoshi Sasaki

Department of Surgery, Toyamaken Saiseikai Takaoka Hospital

A 68 year-old man was admitted to our hospital because of tarry stools. The patient had received a total gastrectomy with Roux-Y reconstruction for early gastric cancer (C, I, 2.0×2.0 cm, tub2, sm, ly1, v0, dw (-), pw (-), n (-), Stage IA) 18 years previously. The patient had also under gone a partial transverse colectomy for early colon cancer (T, IIc, 2×2.5 cm, well, sm, ly1, v0, ow (-), aw (-), n (-), H0, M0, Stage I). Tarry stools and anemia were first noticed in September 1999. A gastrointestinal X-ray examination revealed an apple core sign in the 3rd portion of the duodenum. The patient was diagnosed with a duodenal tumor, and an operation was performed in November 1999. The tumor was located in the 3rd portion of the duodenum, 2 cm proximal to the Treitz ligamentum. A partial duodenectomy was performed. No signs of liver or lymph node metastases were seen. The resected specimen was a type1 tumor that had invaded to the subserosal layer. The histological diagnosis was a well-differentiated tubular adenocarcinoma (well, ss, ly0, v0, ow (-), aw (-), ew (-), n (-)). The tumor was diagnosed as a primary duodenal carcinoma.
Examination of the afferent loop is necessary, if gastrointestinal bleeding occurs after a total gastrectomy with Roux-Y reconstruction.

Key words
primary duodenal carcinoma, total gastrectomy, Roux-Y reconstruction

Reprint requests
Kazushige Shibahara Department of Surgery, Wajima City Hospital ha-1-1, Yamagishi, Wajima city, 928-8585 JAPAN

Accepted
July 25, 2000

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