title: Gastric remnant necrosis following splenic infarction after distal gastrectomy in a gastric cancer patient.
abstract: BACKGROUND
  Distal gastrectomy with lymph node dissection is the standard treatment for gastric cancer. Remnant gastric necrosis after distal gastrectomy is very rare and fatal complication.
  
  
  METHODS
  A-78-year-old male diagnosed with advanced gastric cancer underwent distal gastrectomy with lymph node dissection. Postoperative gastric remnant necrosis occurred following splenic infarction. There was thought to be an insufficient blood supply to the gastric remnant due to the lymph node dissection along the proximal splenic artery during the initial surgery. Non-contrast abdominal computed tomography did not reveal any necrosis in the remnant stomach. An endoscopic examination confirmed this diagnosis. Total remnant gastrectomy was performed, and the patient thereafter successfully recovered.
  
  
  CONCLUSIONS
  Careful management of blood vessels and lymph node dissection above the pancreas should be performed to avoid restricting the blood flow and also to prevent gastric remnant necrosis.
  
  
  CONCLUSIONS
  The knowledge of this fatal complication is crucial for management of postoperative complication. For early and accurate diagnosis, upper gastrointestinal endoscopy is necessary in case of remnant gastric necrosis.
authors.affiliation: Department of Surgery, National Hospital Organization Saga National Hospital, Saga, Japan. Electronic address: hajimeimamura0630@gmail.com.
authors.forename: Imamura
authors.initials: I
authors.lastname: Hajime
authors.forename: Enjoji
authors.initials: E
authors.lastname: Akihito
authors.forename: Nakashima
authors.initials: N
authors.lastname: Hiroharu
authors.forename: Hirabaru
authors.initials: H
authors.lastname: Masataka
authors.forename: Moriuchi
authors.initials: M
authors.lastname: Hiroki
authors.forename: Yamaguchi
authors.initials: Y
authors.lastname: Junzo