A Case Report and Literature Review of Gastric Stump Carcinoma: An Uncommon Entity Following the Billroth II Procedure

TL;DR

This paper reports a rare case of gastric stump carcinoma in a patient who had a Billroth II surgery 30 years earlier and reviews related literature.

Contribution

The paper presents a new clinical case and highlights the importance of recognizing gastric stump carcinoma as a long-term complication of Billroth II surgery.

Findings

An 81-year-old male with a history of Billroth II surgery was diagnosed with gastric stump carcinoma.

Biopsy results showed CDX2-positive cells, confirming gastric adenocarcinoma at the anastomosis site.

The case underscores the need for vigilance in monitoring long-term post-surgery complications.

Abstract

Gastric stump carcinoma is a rare phenomenon and could occur in individuals after a distal gastric resection. Regardless of the surgical approach, it can lead to certain complications. However, the Billroth II gastrojejunostomy procedure has been noted to have some specifically interesting complications due to the anatomical changes it triggers. These changes, such as bacterial overgrowth and enterogastric reflux, can cause metaplasia. We discuss a case of an 81-year-old male with a history of peptic ulcer disease (PUD) status post-Billroth II gastrojejunostomy 30 years prior who presented with a four-day history of bright red blood per rectum. On esophagogastroduodenoscopy (EGD), he was found to have friable, ulcerated mucosa at the anastomosis site. Biopsy results revealed CDX2-positive cells, indicating gastric adenocarcinoma. Although it is well-known that the anatomical changes of gastrojejunostomy will undoubtedly change the microbiome of the stomach, physicians should also be mindful of the more feared complications such as gastric stump carcinoma.

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