Korean J Gastroenterol.  2020 May;75(5):296-299. 10.4166/kjg.2020.75.5.296.

Endoscopic Treatment of a Twisted Small Bowel Obstruction after Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction

  • 1Departments of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
  • 2Departments of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea


This paper reports a case of a twisted small bowel obstruction in a 74-year-old man that occurred after a double tract reconstruction (DTR) in a laparoscopic proximal gastrectomy (PG) for early gastric cancer. The patient had inadequate oral intake and reflux symptoms for 10 days after discharge. Imaging analysis revealed a narrowed small bowel with twists between the esophagojejunostomy and gastrojejunostomy sites. A fully covered stent was placed in the narrowed small bowel for 2 weeks. The patient was then discharged after stent removal without any dietary problems. The authors’ experience shows that twisted small bowel after a DTR in PG can be treated by endoscopy.


Intestine, small; Gastrectomy; Endoscopy; Stents


  • Fig. 1 Upper gastrointestinal series (black arrow: narrowing lumen between the esophagojejunostomy and gastrojejunostomy sites, white arrow: dilated esophagus).

  • Fig. 2 Endoscopic examination revealing a twisted small bowel obstruction approximately 3 cm below the site of the anastomosis site.

  • Fig. 3 Fully covered stent (80 mm in length, HANAROSTENT®; M.I.Tech, Seoul, Korea).

  • Fig. 4 Fully covered stent (80 mm in length) was inserted endoscopically.

  • Fig. 5 (A) Only minor bleeding occurred after stent removal, and there was no perforation or mucosal tearing. Endoscopic findings revealing a dilated small bowel, which showed narrowing prior to stent insertion. (B) Upper gastrointestinal series after stent removal showing good patency of the lumen.


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