Shibata Jumpei, Yoshihara Motoi, Kato Takehito
Department of General Surgery, Toyohashi Municipal Hospital, 441-8570, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan.
BMC Surg. 2020 Mar 19;20(1):54. doi: 10.1186/s12893-020-00716-9.
Distal gastrectomy with lymph node dissection, a standard operative technique for gastric cancer treatment, is safely performed because the stomach has a rich vascular supply. Gastric remnant necrosis caused by cholesterol crystal embolization following distal gastrectomy has not been described previously. We report a case of gastric remnant necrosis in a patient with cholesterol crystal embolization.
A 70-year-old man with a history of cholesterol crystal embolization presented to our surgery department with complaints of anorexia and dysphasia. He was diagnosed with gastric cancer invading the pyloric antrum and underwent distal gastrectomy with Billroth 2 reconstruction. On postoperative day 11, he developed abdominal pain without fever. Emergency laparotomy revealed that most parts of the remnant stomach were necrosed. Total gastrectomy with Roux-en-Y reconstruction and abscess drainage were performed. After surgery, anastomotic leakage occurred and was treated conservatively. However, the superior pancreaticoduodenal artery aneurysm suddenly ruptured and he expired.
Gastric remnant necrosis after distal gastrectomy can be a gastrointestinal presentation of cholesterol crystal embolization. Perioperative/intraoperative risk assessments such as preventive total gastrectomy or intraoperative assessment with indocyanine green fluorescence angiography may be desirable to avoid this complication.
远端胃切除术加淋巴结清扫术是治疗胃癌的标准手术技术，由于胃有丰富的血管供应，该手术可安全实施。远端胃切除术后由胆固醇结晶栓塞引起的胃残余坏死此前尚未见报道。我们报告一例发生胆固醇结晶栓塞的患者出现胃残余坏死的病例。
一名有胆固醇结晶栓塞病史的70岁男性因食欲减退和吞咽困难就诊于我院外科。他被诊断为侵犯幽门窦的胃癌，并接受了毕Ⅱ式重建的远端胃切除术。术后第11天，他出现腹痛但无发热。急诊剖腹探查发现残余胃的大部分已坏死。遂行全胃切除术加Roux-en-Y重建术及脓肿引流术。术后发生吻合口漏，采取保守治疗。然而，胰十二指肠上动脉动脉瘤突然破裂，患者死亡。
远端胃切除术后胃残余坏死可能是胆固醇结晶栓塞的一种胃肠道表现。为避免这种并发症，可能需要进行围手术期/术中风险评估，如预防性全胃切除术或术中使用吲哚菁绿荧光血管造影进行评估。
