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Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report

BACKGROUND: The stomach has many incoming vessels and is resistant to ischemia due to the rich microvascular network within its submucosal layer. Although reports of gastric remnant necrosis after gastrectomy have been rare, mortality rates remain substantially high when present. A double elementary...

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Autores principales: Gakuhara, Atsushi, Fukuda, Shuichi, Tsujimoto, Tomoyuki, Tomihara, Hideo, Ohta, Katsuya, Kitani, Kotaro, Hashimoto, Kazuhiko, Ishikawa, Hajime, Hida, Jin-ichi, Yukawa, Masao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683626/
https://www.ncbi.nlm.nih.gov/pubmed/33226508
http://dx.doi.org/10.1186/s40792-020-01056-9
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author Gakuhara, Atsushi
Fukuda, Shuichi
Tsujimoto, Tomoyuki
Tomihara, Hideo
Ohta, Katsuya
Kitani, Kotaro
Hashimoto, Kazuhiko
Ishikawa, Hajime
Hida, Jin-ichi
Yukawa, Masao
author_facet Gakuhara, Atsushi
Fukuda, Shuichi
Tsujimoto, Tomoyuki
Tomihara, Hideo
Ohta, Katsuya
Kitani, Kotaro
Hashimoto, Kazuhiko
Ishikawa, Hajime
Hida, Jin-ichi
Yukawa, Masao
author_sort Gakuhara, Atsushi
collection PubMed
description BACKGROUND: The stomach has many incoming vessels and is resistant to ischemia due to the rich microvascular network within its submucosal layer. Although reports of gastric remnant necrosis after gastrectomy have been rare, mortality rates remain substantially high when present. A double elementary diet (W-ED) tube, which can be used for both enteral feeding and gastrointestinal tract decompression, has been developed for anastomotic leakage and postoperative nutritional management after upper gastrointestinal surgery. The current report presents a case of gastric remnant necrosis after proximal gastrectomy that was successfully managed through conservative treatment with a W-ED tube. CASE PRESENTATION: A 73-year-old male was referred to our hospital for an additional resection after endoscopic submucosal dissection (ESD) for gastric cancer. Endoscopic findings showed an ESD scar on the posterior wall of the upper portion of the stomach, while computed tomography (CT) showed no obvious regional lymph node enlargement and distant metastases. The patient subsequently underwent laparoscopic proximal gastrectomy and esophagogastrostomy but developed candidemia on postoperative day 7. On postoperative day 14, endoscopy revealed gastric ischemic changes around the anastomotic site, suggesting that the patient’s candidemia developed due to gastric necrosis. His vital signs remained normal, while the gastric remnant ischemia was localized. Given that surgery in the presence of candidemia was considered extremely risky, conservative treatment was elected. A W-ED tube was placed nasally, after which enteral feeding was initiated along with gastrointestinal tract decompression. Although the patient subsequently developed anastomotic leakage due to gastric remnant necrosis, local control was achieved and conservative treatment was continued. On postoperative day 52, healing of the gastric remnant necrosis and anastomotic leakage was confirmed, after which the patient started drinking water. Although balloon dilation was required due to anastomotic stenosis, the patient was able to resume oral intake and was discharged on postoperative day 88. CONCLUSIONS: Herein, we present our experience with a case of gastric remnant necrosis after proximal gastrectomy, wherein conservative management was achieved using a W-ED tube. In cases involving high operative risk, the management should be mindful of gastric remnant necrosis as a post-gastrectomy complication.
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spelling pubmed-76836262020-11-27 Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report Gakuhara, Atsushi Fukuda, Shuichi Tsujimoto, Tomoyuki Tomihara, Hideo Ohta, Katsuya Kitani, Kotaro Hashimoto, Kazuhiko Ishikawa, Hajime Hida, Jin-ichi Yukawa, Masao Surg Case Rep Case Report BACKGROUND: The stomach has many incoming vessels and is resistant to ischemia due to the rich microvascular network within its submucosal layer. Although reports of gastric remnant necrosis after gastrectomy have been rare, mortality rates remain substantially high when present. A double elementary diet (W-ED) tube, which can be used for both enteral feeding and gastrointestinal tract decompression, has been developed for anastomotic leakage and postoperative nutritional management after upper gastrointestinal surgery. The current report presents a case of gastric remnant necrosis after proximal gastrectomy that was successfully managed through conservative treatment with a W-ED tube. CASE PRESENTATION: A 73-year-old male was referred to our hospital for an additional resection after endoscopic submucosal dissection (ESD) for gastric cancer. Endoscopic findings showed an ESD scar on the posterior wall of the upper portion of the stomach, while computed tomography (CT) showed no obvious regional lymph node enlargement and distant metastases. The patient subsequently underwent laparoscopic proximal gastrectomy and esophagogastrostomy but developed candidemia on postoperative day 7. On postoperative day 14, endoscopy revealed gastric ischemic changes around the anastomotic site, suggesting that the patient’s candidemia developed due to gastric necrosis. His vital signs remained normal, while the gastric remnant ischemia was localized. Given that surgery in the presence of candidemia was considered extremely risky, conservative treatment was elected. A W-ED tube was placed nasally, after which enteral feeding was initiated along with gastrointestinal tract decompression. Although the patient subsequently developed anastomotic leakage due to gastric remnant necrosis, local control was achieved and conservative treatment was continued. On postoperative day 52, healing of the gastric remnant necrosis and anastomotic leakage was confirmed, after which the patient started drinking water. Although balloon dilation was required due to anastomotic stenosis, the patient was able to resume oral intake and was discharged on postoperative day 88. CONCLUSIONS: Herein, we present our experience with a case of gastric remnant necrosis after proximal gastrectomy, wherein conservative management was achieved using a W-ED tube. In cases involving high operative risk, the management should be mindful of gastric remnant necrosis as a post-gastrectomy complication. Springer Berlin Heidelberg 2020-11-23 /pmc/articles/PMC7683626/ /pubmed/33226508 http://dx.doi.org/10.1186/s40792-020-01056-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Case Report
Gakuhara, Atsushi
Fukuda, Shuichi
Tsujimoto, Tomoyuki
Tomihara, Hideo
Ohta, Katsuya
Kitani, Kotaro
Hashimoto, Kazuhiko
Ishikawa, Hajime
Hida, Jin-ichi
Yukawa, Masao
Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
title Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
title_full Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
title_fullStr Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
title_full_unstemmed Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
title_short Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
title_sort successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683626/
https://www.ncbi.nlm.nih.gov/pubmed/33226508
http://dx.doi.org/10.1186/s40792-020-01056-9
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