What happened, in summary

A 71-year-old man presented with bloating, vomiting, upper-abdominal pain and a 5-kg weight loss over 2 months. More than 30 years earlier, he had undergone a Billroth II partial gastrectomy for gastric ulcer disease.

Endoscopy showed an infiltrative lesion at the surgical connection in the gastric stump. Biopsy diagnosed moderately differentiated adenocarcinoma. He underwent total gastrectomy with D2 lymph-node dissection, splenectomy, omentectomy and en bloc bowel resection.

On the first postoperative day, he developed hemodynamic instability and was transferred to intensive care. Endoscopy suggested ischemia at the esophagojejunal anastomosis. The team chose conservative treatment with total parenteral nutrition rather than another operation. He died 30 days after surgery.