Necrosis of intraabdominal esophagus and proximal third of the stomach after proximal gastric vagotomy and fundoplication.

Lesser curve necrosis is a rare but known complication of proximal gastric vagotomy (PGV). Incidence seems to increase when PGV is combined with fundoplication. In reports of this complication, the necrosis was of various sizes, but generally limited to the lesser curve. We report a 54-year-old patient with hiatus hernia, severe peptic esophagitis, and increased acid output who developed necrosis of the whole intraabdominal esophagus, cardia, and proximal third of the stomach after PGV and fundoplication with division of several short gastric vessels. A proximal gastric resection with intrathoracic esophagogastric anastomosis had to be performed. After drainage of a subphrenic abscess, the patient made a complete recovery. When combining PGV with a fundoplication, an increased risk of necrosis of the stomach must be considered. Division of the short gastric arteries should be avoided and the original Nissen fundoplication is preferred.