Development of an ulcer in the side-to-side anastomosis of a jejunal pouchafter proximal gastrectomy reconstructed by jejunal interposition: Report of a case

We present herein the first reported case of a deep ulceration developing i n the pouch of a jejunal side-to-side anastomosis following the interpositi on of a jejunal U-shaped pouch (jejunal pouch), performed as reconstruction . A 47-year-old woman underwent a proximal gastrectomy and interposition of a jejunal pouch for early gastric cancer, ii months after which she began to develop a fever. Esophagogastroscopy revealed a deep ulceration in the s ide-to-side anastomosis of the jejunal pouch. Her serum gastrin level was m uch higher than the normal range, and 24-h monitoring of the intraremnant s tomach pH revealed that it was below 7.0 at night, ii peptic ulcer was thou ght to be one of the causes of the pouchitis. Due to the drug-resistant ulc eration and fever, a reoperation was performed, in which the jejunal pouch and remnant stomach were removed and Roux-en-Y reconstruction was done. The re mere no postoperative complications, and the fever resolved after surger y. Reconstruction of the jejunal pouch after proximal gastrectomy is recomm ended from the standpoint of quality of life (QOL); however, further studie s on the size of the remnant stomach and the length of the interposed jejun al pouch are necessary.