Bleeding Ulcer at Braun Anastomosis in Distal Gastrectomy Billroth II Reconstruction: A Case Report

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  • 上部消化管出血の原因がBraun吻合部の出血性潰瘍であった，幽門側胃切除術Billroth Ⅱ法再建後の1例
  • 症例報告 上部消化管出血の原因がBraun吻合部の出血性潰瘍であった,幽門側胃切除術BillrothⅡ法再建後の1例
  • ショウレイ ホウコク ジョウブ ショウカカン シュッケツ ノ ゲンイン ガ Braun フンゴウブ ノ シュッケツセイ カイヨウ デ アッタ,ユウモンガワ イ セツジョジュツ Billroth Ⅱ ホウ サイケン ゴ ノ 1レイ

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A man in his 50's was referred to our hospital for hematemesis and hematochezia. He had previously presented to another hospital for ulcerative colitis that was in remission with a prescription of 11 mg prednisolone and adalimumab. He also had a history of partial gastrectomy. Although detailed information on the gastrectomy was unavailable upon arrival at our hospital, contrast-enhanced computed tomography scan suggested that he had undergone a distal gastrectomy with Billroth II reconstruction. Emergency upper gastrointestinal endoscopy revealed an ulcer with an exposed blood vessel at the Braun anastomosis; thus, clipping hemostasis was performed. However, hematemesis occurred 3 days later, and another emergency upper gastrointestinal endoscopy revealed that the clips at the Braun anastomosis had deviated from the original position; therefore, clipping hemostasis was repeated to stop the bleeding from the exposed blood vessels. Subsequently, he was provided intravenous hyperalimentation, after which he resumed oral intake 14 days after the second clipping. No bleeding was observed after the second clipping, and he was discharged 22 days after admission.

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