We report a case of small intestinal cancer arisen in the elevated intestine after total gastrectomy.
An 81-year-old man, who had have uneventful course after total gastrectomy for gastric cancer on May 10, 2002, was found to have a tumorous lesion in the elevated intestine for reconstruction by an endoscopic study on May 27, 2003. Biopsy resulted in group V. Determined that he had no other metastases than the lesion based on abdominal CT and ultrasonic findings, we performed operation. No findings suggestive of metastasis were seen in the abdomen, and so the elevated intestine was dissected and transected as much as possible and reconstructed by Roux-Y anastomosis again. Histopathologically it was moderately differentiated adenocarcinoma.
We think that the tumor is primary small intestinal cancer from the following etiological reasons; 1) histological type of the gastric cancer was poorly differentiated adenocarcinoma; 2) it is too distant to consider it as scattered cancer cells at the initial operation; 3) and the location of this small intestinal cancer was in the jejunum within 50 cm from the Treitz' ligament before it was elevated, where is the common site for cancer of the small intestine.