Early Stomach Cancer Surgery Followed by a Rare Bowel Complication

What happened, in summary

A 75-year-old woman was referred for treatment of early-stage gastric cancer. The tumor was a depressed lesion on the lesser curvature of the middle stomach and was confirmed as poorly differentiated adenocarcinoma. Clinical staging was cT1bN0M0, Stage I. She underwent laparoscopic distal gastrectomy with D1+ lymph-node dissection and Roux-en-Y reconstruction. After discharge, she developed vomiting episodes about every 10 days. Intravenous fluids and antiemetic medication provided temporary relief, and her oral intake and nutritional status remained largely stable. During routine postoperative cancer surveillance, a contrast-enhanced CT scan showed transient jejunal intussusception at the surgical connection, raising concern that the bowel was intermittently folding into itself. She chose reoperation. Although no active intussusception was seen during laparoscopy, the surgical connection was mildly enlarged and the biliopancreatic limb measured about 40 cm rather than the intended 25 cm. Surgeons removed and reconstructed the previous connection, adjusted the limb to 25 cm, and created an anastomosis about 30 cm from the gastrojejunostomy. The operation lasted 131 minutes with an estimated blood loss of 12 mL. Recovery was uncomplicated, and she left hospital on postoperative day 10. During 6 months of follow-up, the vomiting did not return.