title: Gastrectomy with isoperistaltic jejunal parallel pouch in a 15-year-old adolescent boy with gastric adenocarcinoma and autosomal recessive agammaglobulinemia.
abstract: A 15-year-old adolescent boy with autosomal recessive agammaglobulinemia underwent endoscopy because of unexplained growth failure and malnutrition. Esophagogastroduodenoscopy revealed antropyloric stenosis, and a biopsy showed an invasive gastric adenocarcinoma. Chronic atrophic corpus gastritis type A and Helicobacter pylori were also identified. Abdominal magnetic resonance imaging confirmed the stenosis resulting from a semicircular intramural tumor without obvious local or distant metastatic spread. Gastrectomy with an extended lymphadenectomy was performed. Esophagoduodenal continuity was restored by an interposed jejunal parallel pouch developed from the first jejunal loop. Oral feeding was supplemented by parenteral nutrition via a Broviac catheter, and the patient is well 4 months later. Several cases of gastric cancer have been reported in children with hereditary agammaglobulinemia. Thus, endoscopy is mandatory in such patients with gastrointestinal symptoms to identify and treat tumors before metastasis occurs. Total gastrectomy, extended lymphadenectomy, and reconstruction using a jejunal reservoir with maintenance of duodenal continuity should be considered.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of the Saarland, D-66421 Homburg/Saar, Germany. jan.e.slotta@uks.eu
authors.forename: Jan E
authors.initials: JE
authors.lastname: Slotta
authors.forename: Sabine
authors.initials: S
authors.lastname: Heine
authors.forename: Anne
authors.initials: A
authors.lastname: Kauffels
authors.forename: Thomas
authors.initials: T
authors.lastname: Krenn
authors.forename: Frank
authors.initials: F
authors.lastname: Grünhage
authors.forename: Mathias
authors.initials: M
authors.lastname: Wagner
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schilling
authors.forename: Jochen
authors.initials: J
authors.lastname: Schuld
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000601:surgery*; D000293:Adolescent; D000361:Agammaglobulinemia / Q000150:complications*; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D010528:Peristalsis; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000150:complications* / Q000601:surgery*; D019738:Surgically-Created Structures