Ischemic Necrosis of the Gastric Remnant without Splenic Infarction Following Subtotal Gastrectomy

Abstract

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.

Gastric remnant necrosis secondary to cholesterol crystal embolization after distal gastrectomy in a gastric cancer patient: a case report

“…Several reported cases have occurred secondary to splenic infarction [3]. However, some cases with a preserved splenic artery, as in the present case, have also been reported [16]. The patient in our case suffered subtotal necrosis of the remnant stomach, revealing severe blood flow reduction.…”

Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report

“…Considering that gastrectomy preserves the right gastric artery and right gastroepiploic artery, blood flow to the gastric remnant is maintained. Although gastric remnant necrosis has been reported after distal gastrectomy [3][4][5][6][7], to the best of our knowledge, no cases of gastric remnant necrosis have been reported after proximal gastrectomy. Smoking, diabetes mellitus, hypertension, and hyperlipidemia have been identified as risk factors for gastric necrosis [13], particularly during Billroth-I reconstruction where excessive extension and torsion are expected [6].…”

“…Smoking, diabetes mellitus, hypertension, and hyperlipidemia have been identified as risk factors for gastric necrosis [13], particularly during Billroth-I reconstruction where excessive extension and torsion are expected [6]. In fact, reports of cases of gastric remnant necrosis after distal gastrectomy were more common in males and after Billroth-I reconstruction [7]. Considering that our patient was male and had been treated for hypertension, dyslipidemia, and atherosclerosis and had a history of treatment for arteriosclerosis-related diseases, our patient can be considered a high-risk case.…”

“…Gastric remnant necrosis can be diagnosed through CT and endoscopy, although reports have suggested that endoscopy is the more helpful for the early diagnosis of ischemic changes in the gastric wall [7]. The time to diagnosis of gastric remnant necrosis was reported to be about 1 week postoperatively [7].…”

“…The stomach has numerous incoming vessels and is resistant to ischemia due to the rich microvascular network in its submucosal region [1,2]. Although reports of gastric remnant necrosis after gastrectomy have been rare [3][4][5][6][7], mortality rates have been considerably high when present [6,7]. A double elementary diet (W-ED) tube, which can be used for both enteral feeding and gastrointestinal tract decompression [8][9][10][11], had been developed for anastomotic leakage and postoperative nutritional management after upper gastroenterological surgery [8][9][10][11][12].…”