Gastric cancer after Roux-en-Y gastric bypass

case report

Abstract

Introduction: The incidence of gastric adenocarcinoma in patients undergoing Roux-en-Y gastric bypass (BPGYR) is rare. Over the past 10 years, just over 30 cases have been reported, most of which were in the excluded stomach. The pathogenesis is still unknown. However, it is believed that chronic reflux, H. pylori infection and gastric stasis of undigested food would be associated with the genesis of cancer. Symptomatology usually includes nonspecific symptoms, the most common being abdominal pain. The most accurate diagnostic method is upper GI. However, the difficulty in accessing the remaining stomach in patients submitted to bypass, ends up delaying the diagnosis in these patients. Case Report: A 68-year-old woman who had been submitted to BPGYR for morbid obesity 15 years ago presented with epigastric pain and melena, and a mass was identified by computed tomography of the abdomen and Upper GI. In view of persistent bleeding and acute anemia, laparotomy with total gastrectomy and esophageal-jejunal anastomosis was performed. Histology showed a well differentiated adenocarcinoma. Surgery had no major bleeding and no further complications. Patient was discharged and had adjuvant chemotherapy. Gastric adenocarcinoma´s symptomatology is unspecific in most of the patients. Its diagnosis is also postponed because it is very difficult to analyze of the excluded stomach. When these patients present general and unspecific symptoms, it is recommended to perform a CT scan or an Upper GI in a center of excellence.