A 60-year-old woman with no relevant personal history was admitted to the Digestive Service due to epigastric pain, general syndrome and hypochromic microcytic anemia. She was diagnosed with stenosing antral gastric neoplasia.
At that time, the nutritional unit evaluated the patient, starting support with total parenteral nutrition (TPN) pending completion of studies and surgical scheduling.
On day 14 of admission a subtotal gastrectomy with Roux-en-Y reconstruction was performed.
Peritonitis and peritonitis developed well initially, but 7 days after surgery the patient presented sudden deterioration.
He underwent urgent laparotomy for necrosis of lesser gastric curvature and distal esophageal face with associated peritonitis.
Transsection and closure of the abdominal esophagus and gastric stump were performed, as well as esophageal exclusion with cervical stenosis and placement of a feeding jejunostomy.
The patient remains in the resuscitation unit until the septic picture is stabilized.
Enteral nutrition (EN) was started due to a jejunostomy on the first postoperative day.
After a slow recovery, the patient was discharged 2 months after admission with home-based NE (HEN) due to cystostomy.
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Three months later the patient was readmitted for transit reconstruction.
Previously, a computerized axial tomography was performed, in which no signs of recurrence were observed, and a normal appearance was observed.
After laparotomy, micronodules are observed in the transverse colon and in the region corresponding to the gastrohepatic omentum.
Intraoperative pathology is compatible with signet ring cells, so it is decided not to perform reconstruction.
The patient was discharged with an upper digestive endoscopy.
