INTRODUCTION: Pancreaticobiliary obstruction is an uncommon complication of total gastrectomy with Roux-en-Y reconstruction. We present a case of a patient with a closed loop obstruction due to a hematoma at the location of jejunojejunal anastomosis. The patient underwent EGD with clot evacuation resulting in decompression of the pancreaticobiliary limb. CASE DESCRIPTION/METHODS: A 57-year-old male, with hypertension, who had recently immigrated from China presented for evaluation of persistent heartburn. He underwent an upper endoscopy, which showed erythematous gastric mucosa and pathology was positive for superficial invasive adenocarcinoma. He was referred to surgery and underwent laparoscopic esophagogastroduodenoscopy, robotic assisted total gastrectomy and Roux-en-Y reconstruction with jejunostomy tube placement. On postoperative day one, there was bright red blood on aspiration from his nasogastric tube and J-tube. Laboratory tests were notable for downtrending hemoglobin and he required 2 units of packed cells. Due to concern for active bleeding, the patient underwent an upper endoscopy in the operating room, which demonstrated no active bleeding and presence of a blood clot at the JJ anastomosis. Epinephrine was injected at the site of the clot. Post procedure, he had increasing total bilirubin which peaked at 5.9. A computed tomography was done on postoperative day 3, demonstrating marked dilation of the pancreaticobiliary limb, which was suspicious for a clot within the small bowel at the level of the JJ anastomosis, concerning for a closed loop obstruction. He then underwent a repeat endoscopy using a duodenoscope. A 9 cm clot was visualized at the JJ anastomosis causing pancreaticobiliary obstruction. The clot was removed with cold soft snare, grasping forceps and roth net with resultant free flow of bile at the site of JJ anastomosis. Total bilirubin subsequently downtrended and returned to normal. The patient's recovery was uneventful, and he was discharge 16 days after clot evacuation. DISCUSSION: The most common early complications of total gastrectomy with Roux-en-Y reconstruction include SBO and anastomotic leak. Our case highlights a rare complication of pancreaticobiliary limb obstruction due to hematoma at the JJ anastomosis. Early EGD allowed for clot evacuation and limb decompression without need for re-operation.