What happened, in summary

A 72-year-old man presented with about a month of upper-abdominal distension, nausea and vomiting. Endoscopy showed a large tumor in the gastric antrum extending to the pylorus, and biopsy confirmed mucinous adenocarcinoma. Imaging showed extensive nodal disease. He underwent reductive distal gastrectomy with Billroth I reconstruction.

His early postoperative course included abdominal fluid collections and an incision infection, both of which improved with drainage, antibiotics and supportive care. He was discharged 29 days after surgery.

Eight days later, he developed renewed abdominal distension, nausea and vomiting, followed by right-upper-abdominal pain and fever. Ultrasound showed a markedly enlarged gallbladder with surrounding inflammation, consistent with acute acalculous cholecystitis. A percutaneous gallbladder drainage tube was placed immediately, and antibiotics were continued.

His fever and abdominal pain resolved by the next day. He resumed a semi-fluid diet and was discharged 5 days after readmission. The drainage tube was removed on day 19.