Palliative double bypass for a Roux en Y loop obstruction in a solitary recurrence of gastric cancer after total gastrectomy with multivisceral resection - A rare case report

A 48 years old male underwent total gastrectomy with multivisceral resection with a curative intent for proximal gastric malignancy in the absence of peritoneal disease and metastasis. Adjuvant chemotherapy with six cycles of cisplatin and 5 FU regimen was administered. A symptomatic solitary recurrence has occurred thirty months following the primary operation involving the jejuno-jejunostomy forming a mass near the remnant pancreas causing a partial Roux and Y loop obstruction. A double surgical bypass was performed between duodenal limb to jejunum and roux limb to jejunum both beyond jejuno-jejunostomy site. FNAC from the mass confirmed local recurrence of gastric adenocarcinoma infiltrating pancreas and jejunum. Patient had symptomatic relief following surgery.