A Case of Extended Operation for Gastric Cancer Accompanied with Gastrojejunal Fistula and Pancreas Invasion

Satoshi Souma, Kiwao Ishimoto and Harumasa Ohyanagi*

Department of Surgery, Fujii Hospital
Department of Surgery, Kinki University Hospital*

A 55-year-old man seen for epigastralgia and weight loss was found in barium radiography and endoscopic study to have a Borrmann type 3 tumor with a gastrojejunal fistula. At laparotomy, we found that the gastric tumor had extensively invaded to the transeverse mesocolon, jejunum, and pancreas, although no liver metastasis or peritoneal dissemination was seen. We conducted total gastrectomy with en bloc resection of the pancreas body and tail, spleen, transeverse colon and jejunum, followed by double-tract reconstruction, i.e.) the jejunum and transeverse colon were reconstructed by end-to-end anastomosis. The postoperative course was relatively uneventful, despite transient cholecystitis, and the man was discharged on postoperative day 40. He has gained eight kilograms and is recurrence-free 18 months after the operation. Gastrojejunal fistula secondary to gastric cancer is very rare. Our patient is, to our knowledge, only the fifth reported in the world. Extended curative surgery is the sole choice of treatment.

Key words
gastric cancer, gastro-jejunal fistula, extended operation

Reprint requests
Kiwao Ishimoto Department of Surgery, Fujii Hospital
3-1 Nishinouchicho, Kishiwada-shi, 596-0044 JAPAN

Accepted
April 28, 2004

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