A 69-year-old male patient with a history of partial gastrectomy 30 years ago for peptic gastric ulcer with Billroth II reconstruction was admitted for eight days of clinical manifestations consisting of abdominal pain located in the mesogastrium together with a slight increase in serum amylase and lipase levels (amylase 550 IU/l, lipase 5976 IU/l). Abdominal ultrasound showed a distended gallbladder together with dilatation of the intra- and extrahepatic bile ducts and a large thin-walled cystic formation of tubular morphology occupying from left hypochondrium to right void, suggesting a dilated and fluid-filled afferent loop. CT and MRI confirmed these findings. Upper gastrointestinal endoscopy revealed thickened folds in the gastric stump obstructing the afferent loop, suggesting neoplastic infiltration, which was confirmed after histological study of the endoscopic biopsies. The patient underwent surgery, with total gastrectomy and oesophago-jejunal anastomosis.

