Abstract
A 85-year-old man was admitted because of gastric cancer and underwent subtotal gastrectomy with regional lymph node dissection. Abdominal pain was experienced on the 37th postoperative day, and signs of peritoneal irritation developed on the 39th day. CT revealed a small amount of ascites and a thickened small bowel wall with a narrow lumen, but no evidence of perforation. On the 40th day, an upper gastrointestinal study with oral Gastrografin showed tubular narrowing of the small bowel and the absence of mucosal folds, while 3-hour follow-up films showed opacification of the renal pelvis, ureter and bladder. The films also showed delayed passage of the Gastrografin. This was interpreted as indicating perforation of the intestine or breakdown of the bowel anastomosis. Laparotomy was performed, but no perforation or breakdown was detected. We think that the Gastrografin was absorbed through the ischemic small bowel as seen in conditions in which there is intestinal stasis and dehydration of the patient.
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