A case of gastric adenocarcinoma extirpated with total gastrectomy involving jejunal pouch reconstruction

Abstract

Gastric adenocarcinoma usually has a poor prognosis due to its late diagnosis in most cases. Gastric adenocarcinomas account for 95% of all malignant tumors of the stomach. In this report, we described a case of a 63-year-old man who presented with pain in the epigastric region for 1 month which was associated with hematemesis and loss of appetite. The upper gastrointestinal endoscopy (UGIE) revealed an ulcer of size 3 cm × 3 cm in the lesser curvature of the stomach. The patient underwent open total gastrectomy, dissection D2, and a jejunal pouch of 30 ml additional capacity was created 20 cm distal to duodenojejunal flexure and passed retrocolic from a rent in transverse mesocolon. The patient was sent to chemoradiotherapy after the surgery and discharged on the 24th day after surgery. Postoperative biopsy revealed tumor tissue showing irregular, ill-defined, and glandular clouding with loss of polarity. Infiltration was up to the muscularis layer and mesenteric lymph nodes showed partial effacement of architecture with reactive changes and few multinucleated foreign body giant cells confirming the diagnosis as poorly differentiated adenocarcinoma of the stomach of II B class (T2 N2 M0) as per the Union for International Cancer Control guidelines.