A Case of Intestinal Obstruction Caused by a Staple Used for Delta-shaped Anastomosis in Laparoscopic Distal Gastrectomy

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  • 腹腔鏡下幽門側胃切除のデルタ吻合部のステイプルにより腸閉塞をきたした１例

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Abstract

<p>An 84-year-old man underwent laparoscopic distal gastrectomy with a delta-shaped anastomosis. He developed paralytic ileus, but the symptoms improved with conservative treatment. On day 6 after the surgery, he resumed oral intake, and was discharged on day 14. However, on day 20 after the surgery, he presented with abdominal distention and vomiting. Abdominal computed tomography showed obstruction of the jejunum with dilatation of the proximal segment, suggesting intestinal obstruction caused by adhesion at the delta-shaped anastomosis. The symptoms improved with decompression. However, as the symptoms recurred, we decided to perform reoperation. Laparoscopic observation revealed the jejunum climbing over the transverse colon and adhering solidly to the anterior of anastomosis. The cause of the adhesion was considered to be a staple used for the common channel closure. We performed adhesiolysis and partial bowel resection. The patient’s postoperative course was uneventful and he was discharged 10 days after the reoperation.</p><p>Delta-shaped gastroduodenostomy is a standard surgical procedure in laparoscopic gastrectomy. Although intestinal obstruction caused by staples is a very rare complication, the possibility of staple-related complications must be borne in mind and appropriate measures should be taken, such as a single-layer suture for the entry hole without a staple, while performing delta-shaped anastomosis.</p>

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