Postoperative gastric mycosis.

Significant symptoms postoperatively may be associated with massive growth of yeast organisms in the gastric remnant. Contrary to reports in the literature, the roentgenologic appearance is suggestive but not diagnostic of the presence of gastric mycosis. In our series, roentgenologic studies, gastroscopy and direct microscopic examination of the gastric contents have been required to establish the diagnosis of gastric mycosis. In our experience, as well as in that of other reported series, gastric mycosis has been most frequently seen following vagotomy and antrectomy with Billroth I reconstruction. The physiopathology is speculative, but abnormal gastric emptying of solids, increased intragastric pH and reflux of duodenal contents into the stomach are strongly suggestive factors. Treatment of this condition, as reported in the literature, has been empiric and not quite successful. Our treatment protocol has given us more satisfactory results. Postoperatively, gastric mycosis is a benign condition not associated with obstruction of the gastric outlet or the intestine, gastric hemorrhage, anemia or peforation. Aggressive treatment is not justified in the absence of severe symptoms. If the reflux of duodenal contents is suspected to be an important contributing factor, reconstruction of the gastric outlet using the Roux-en-Y principle may give gratifying results.