Gastric cancer causing obstructive jaundice after prior Billroth II surgery

What happened, in summary

An 84-year-old man with a remote history of Billroth II gastrectomy for peptic ulcer disease developed a month of poor appetite, weight loss, fatigue and progressive painless jaundice. Imaging did not show the usual dilated bile ducts or a liver or pancreatic mass, creating uncertainty about the cause of the obstruction.

Gastroscopy eventually found a malignant-appearing mass at the gastroenteric anastomosis in the remaining stomach. Biopsy confirmed moderately differentiated gastric adenocarcinoma. The tumor had narrowed the afferent duodenal limb and was blocking normal biliary drainage through the altered postoperative anatomy.

An endoscopic wire-guided stent was placed through the obstructing tumor into the afferent limb. His jaundice and liver tests improved substantially after the procedure. Because of the local extent of the cancer and his frailty, surgery and chemotherapy were not pursued. After a period of inpatient rehabilitation, he was discharged home with palliative support.

He continued living with locally advanced gastric cancer after the jaundice was relieved, with care focused on comfort and support at home.