Fedorov V.E.1, Barsukov V.Yu.1, Podelyakin K.A.1, Masljakov V.V.2
1 Saratov State Medical University named after V.I. Razumovsky, Saratov
2 Mari State University, Joshkar-Ola
Purpose. Improving the quality and timeliness of diagnosis of leakage of the esophagojejunal anastomosis after gastrectomy.
Methods and materials are presented by the description of a case of examination and treatment of patient K., 58 years old, with a malignant neoplasm of the stomach. The active manifestation of the disease began with profuse gastric bleeding, which led to an emergency operation. Surprisingly, an anaplastic gastric cancer was discovered when examining a postoperative preparation. After discharge with a control fibrogastroscopy performed on an outpatient basis, a biopsy of the scar in the stomach re-verified the diagnosis. In this regard, the patient was admitted for surgical treatment in a planned manner. It consisted of gastrectomy with jejunoplasty, pancreatic tail resection and D2 lymphadenectomy.
Results. In the postoperative period, the patient developed a subphrenic abscess on the left, the cause of which was the failure of the esophageal-small intestinal junction, which proceeded with an atypical clinical picture. Risk factors for complications after gastrectomy were identified: a high degree of malignancy of the tumor process, asthenization and anemia after emergency surgery for profuse gastric bleeding. With multiple fibrogastroscopy in this patient, it was found that the key role in the development of leak of esophagojejunostomy was played by the staple bracket used when applying circular esophagojejunostomy.
Conclusion. With a combination of multiple risk factors for postoperative complications after gastrectomy, it is possible to develop leakage of esophagojejunal anastomosis with an unusual cause and an atypical course.
Keywords: gastric cancer, gastrectomy, circular stapling apparatus, postoperative complications, anastomotic leakage.
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