# Supradiaphragmatic Jejunal Perforation Following Total Gastrectomy With Esophagojejunostomy Reconstruction for Gastric Adenocarcinoma

## TL;DR

A rare case of jejunal perforation after gastric cancer surgery is linked to nasogastric tube decompression, leading to pleural effusion and conservative treatment.

## Contribution

This case highlights a rare but serious complication of routine nasogastric decompression following gastric surgery.

## Key findings

- Supradiaphragmatic jejunal perforation occurred following nasogastric tube decompression after total gastrectomy.
- The patient developed left pleural effusion, diagnosed via endoscopy, and was managed conservatively.
- The patient was discharged 28 days post-surgery after conservative treatment.

## Abstract

Nasogastric tube decompression is a common technique used after abdominal surgery as it is widely accepted to play a role in the management of postoperative ileus and possibly reduce anastomotic leaks after gastrointestinal surgery. However, the routine practice of nasogastric/nasoenteric tube decompression in elective abdominal surgeries has been challenged due to the increased incidence of pulmonary complications and the argued lack of expected benefit. Here, we present a rare complication of nasogastric tube drainage following a routine total gastrectomy for signet-ring cell adenocarcinoma of the cardia in a 43-year-old female. Her postoperative course was complicated with a supradiaphragmatic jejunal perforation presumably from nasogastric tube decompression resulting in a left pleural effusion. The workup included an endoscopy showing the perforation, after which the nasojejunal tube was removed and the patient was managed conservatively. She was eventually discharged on postoperative day 28.