Woubet T Kassahun¹, Peter Lamesch¹, Christian Wittekind², Matthias Neid², Jens P Schneider³, Joachim Mössner⁴ and Johann Hauss¹

¹Department of Surgery II, University of Leipzig, Liebig Strasse 20, 04103 Leipzig, Germany. ²Institute of Pathology, University of Leipzig, Liebig Strasse 26, 04103 Leipzig, Germany. ³Department of Diagnostic Radiology, University of Leipzig, Liebig Strasse 20, 04103 Leipzig, Germany. ⁴Department of Internal Medicine II, University of Leipzig, Philipp-Rosenthal Strasse 20, 04103 Leipzig, Germany.

Abstract

The development of malignancy in the gastric stump following surgery for peptic ulcer disease is well recognized. There are also few reports on carcinomas occurring after surgery for malignant gastric disease. However, carcinoma of the gastric stump after duodenopancreatectomy is extremely rare. We describe what we believe to be an unusual case of signetring cell carcinoma of the gastric stump developing at the anastomotic site 5 years after duodenopancreatectomy for ductal adenocarcinoma of the pancreatic head. We performed remnant gastrectomy and Roux-en-Y gastrojejunostomy as a curative resection. This experience clearly underlies that gastric stump carcinoma (GSC) may mimic metastatic disease recurrence leading to diagnostic confusion after surgery for malignancy. Although an increased risk of gastric stump carcinoma after pancreatoduodenectomy for pancreatic cancer has not been established, the possibility of such a complication should be kept in mind when evaluating patients after gastric resection who present with symptoms of metastatic disease recurrence years after the primary operation. Investigations should be independent of the entity of the primary disease or its localization, since GSC may well be amenable to surgical cure as demonstrated in the presented case. Outpatient follow up results of the last four years indicated no recurrence in this case.