A Case of Primary Cancer of The Small Intestine Originated in The Efferent Loop after Billoth-II Reconstruction

Masataka Takebayashi, Nobuhiko Toyota, Kimiyasu Nozaka, Toshiro Wakatsuki, Akira Kamasako and Osamu Tanida

Department of Surgery, San-in Rosai Hospital

A 79-year-old man who had undergone gastrectomy with Billroth II reconstruction for a duodenal ulcer 32 years earlier was found in routine gastroscopic examination of the residual stomach to have a tumor involving a 12 cm efferent loop from the anastomosis site, which was diagnosed by biopsy as cancer. Tumor markers were normal. At surgery, no liver metastasis, peritoneal dissemination, or lymph node metastasis was observed, and a partial jejunostomy was done. The resected specimen showed a 2.5×2.2 cm elevated lesion. Histopathological examination indicated well-differentiated adenocarcinoma with a villous pattern and a cribriform pattern in the deep layer, partly intermingled with mucinous and poorly differentiated adenocarcinoma in some areas, thus showing a diverse histological appearance. Immunohisto-chemical staining for gastric differentiation markers (expression of the gastric trait) was positive. We report this case because it is extremely rare for small intestinal cancer to arise in an efferent loop after Billroth II reconstruction.

Key words
cancer of small intestine, Billroth II reconstructin

Reprint requests
Masataka Takebayashi Department of Surgery, San-in Rosai Hospital
1-8-1 Kaike, Sinden, Yonago, 683-8605 JAPAN

Accepted
September 26, 2007

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