title: Subtotal gastrectomy for diffused hemorrhagic gastritis induced by radiation, following liver resection for hilar cholangiocarcinoma. A case report.
abstract: BACKGROUND
  A rare case of hemorrhagic gastritis induced by radiation is presented, which was resistant to conservative treatment and required subtotal gastrectomy.
  
  
  METHODS
  A 56-year-old male was initially undergone right hepatectomy, resection of the extrahepatic biliary tree, hilar lymph node dissection and hepatico-jejunostomy due to advanced hilar cholangiocarcinoma. Because of the extent of the disease, chemo-radiotherapy was administered. The patient received a total radiotherapy dose of 57.6Gy in 32 sessions. Unfortunately, diffused hemorrhagic gastritis induced by radiation was developed, which was resistant to conservative treatment (endoscopic hemostasis, transfusion). A subtotal gastrectomy was performed. The patient is in good condition 45 months after the liver resection, but with local recurrence.
  
  
  CONCLUSIONS
  In resistant situations to conservative treatment and recurred bleeding of diffused hemorrhagic gastritis induced by radiation, surgical management may have a role.
authors.affiliation: Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece. Electronic address: tatsis.vasileios@hotmail.com.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Tatsis
authors.affiliation: Department of Radiotherapy, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Evaggelia
authors.initials: E
authors.lastname: Peponi
authors.affiliation: Department of Anesthesiology and Postoperative Intensive Care Unit, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Papadopoulos
authors.affiliation: Department of Radiotherapy, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Tsekeris
authors.affiliation: Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Fatouros
authors.affiliation: Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Glantzounis
keywords: Chemotherapy; Gastrectomy; Hemorrhagic gastritis induced by radiation; Radiotherapy; Surgical treatment