Adenocarcinoma in long-segment Barrett's esophagus 44 years after total gastrectomy
In October 2011, a 74-year-old male was admitted to our hospital due to ulceration of the upper to middle thoracic esophagus. The patient had undergone total gastrectomy because of ulcerative stricture of the esophagogastric junction at the age of 30. Following this surgery, he had recurrent bile acid reflux for >40 years which had increased in frequency from 10 years ago. When the patient was 62 years old, an endoscopic examination revealed long-segment Barrett's esophagus, and he subsequently underwent yearly check-up and endoscopic examinations. Irregular mucosa was found 27 cm from the incisors, and the oral margin of Barrett's esophagus was 17 cm from the incisors (Fig. ). Frequent bile regurgitation was found during an endoscopic examination. Pathological examination of biopsied specimens from the irregular mucosa revealed adenocarcinoma.\nAlthough adenocarcinoma was thought to be limited to the mucosal layer, the patient requested resection for adenocarcinoma as well as Barrett's esophagus due to intractable bile reflux. We performed subtotal esophagectomy with lymph node dissection in the prone position and reconstructed the esophagus with ileocolic interposition. During laparotomy, we confirmed that jejunojejunostomy was located 10 cm from esophagojejunostomy. Postoperative pathological diagnosis from a Barrett's epithelial section was well-differentiated adenocarcinoma (T1a 2.0 × 3.0 cm) (Figs. and ). There was no lymph node metastasis (N0).\nAlthough free jejunal graft was needed due to anastomotic leakage at the site of esophagoileostomy, he was discharged 110 days after the first surgery. Final resection of the remaining Barrett's epithelium was performed concurrently with free jejunal graft. He is now well and without any evidence of recurrence.