胃空腸吻合術後40年してみられた吻合部早期胃癌の1例

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  • A CASE OF EARLY GASTRIC STOMAL CANCER OCCURRED 40 YEARS AFTER GASTROJEJUNOSTOMY

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We experienced a case of early gastric cancer of the anastomosed site occurred about 40 years after a gastrojejunostomy for gastroptosis.<br> A 69-year-old woman was admitted to the hospital because of rectal bleeding of bright red in color. There was a previous history of undergoing gastrojejunostomy for gastroptosis at the age of 29. After admission upper gastrointestinal endoscopy visualized a relatively sharrow depression with slightly rough mucosa surface and two polypoid elevated lesions arround the anastomosed site. The patient was diagnosed as having a type IIc gastric cancer and gallstone. Subtotal gastrectomy (B-I) mainly involving the anastomosed site, partial excision of the jejunum with end-to-end anastomosis, and cholecystectomy were carried out. Histopathologically the cancer lesion was intramucosal cancer (tub2) growing around the oral side of the anastomosis, without infiltration into the jejunum nor lymph node metastasis.<br> There have been 34 cases of gastric cancer following gastrojejunostomy including this case so far. Their average age was 62.3 years. The disease was common in men and often appeared following the operation for peptic ulcer. Their gastric cancers were detected after an average disease-free interval of 27.4 years. Gastric cancers frequently appeared at the anastomosed site and the half of them were in an early stage.

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