A Case of Severe Reflux Esophagitis after Total Gastrectomy Cured by Reoperation

Takamasa Takahashi, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Goto, Hideo Miyake, Keiichi Nagasawa, Atsushi Yasue, Kenji Omori and Yoichiro Kobayashi

Department of Surgery, Japanese Red Cross Nagoya First Hospital

A 72-year-old man undergoing total gastrectomy followed by Roux-en-Y reconstruction for gastric cancer (pT1, pN0) and subsequently admitted for severe heartburn and appetite and weight loss was found in endoscopy to have severe reflux esophagitis (Grade D based on the Los Angels' classification). 24 hour Bile reflux was 33.4% in predominantly supine with 24-hour bilirubin monitoring. Upper gastrointestinal radiography showed the distance between the esophagojejunostomy and jejunojejunostomy to be short (30 cm), considered to cause severe reflux esophagitis, necessitating reoperation in which the jejunojejunostomy was divided and the oral jejunum anastomosed to the jejunum 1 m distal to the previous jejunojejunostomy. After reoperation, heartburn subsided and 24-hour bilirubin monitoring disclosed no bile reflux. Endoscopy 3 months later showed no reflux esophagitis. Esophageal 24-hour bilirubin monitoring in the esophagus enable to objectively analyze duodenal fluid reflux and initiate appropriate treatment.

Key words
reflux esophagitis, bile reflux, total gastrectomy

Reprint requests
Takamasa Takahashi Department of Surgery, Japanese Red Cross Nagoya First Hospital
3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511 JAPAN

Accepted
September 26, 2007

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