PMC5910517_01
Upper gastrointestinal series showing a dilated gastric pouch with air-fluid level (A) and an elevated lesion projecting into the stomach at the anastomosis site (B). No passage of the anastomosis site was obeserved even when applying pressure onto the stomach.
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Gastrojejunostomy stricture was suspected and an upper GI series was performed, which revealed a dilated gastric pouch with air-fluid level and no passage of the Roux-en-Y limb (Fig. 1).
Gastrointestinal endoscopy showing an elevated lesion with ring-like folds protruding, and with a green caterpillar-like appearance, through the anastomosis site into the remnant stomach (A). The anastomosis site was stenosed, and an endoscope could not pass through it (B).
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Gastroendoscopy revealed elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach, and anastomotic stenosis in the gastrojejunal anastomosis site (Fig. 2).
Abdominal computed tomography scan showing the elevated lesion protruding to the remnant stomach (A). A metallic piece which seems to be linear stapler was recognized inside the elevated lesion (B).
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CT also showed the elevated lesion protruding into the remnant stomach (Fig. 3).
Macroscopically, the jejunal stump was inverted into the remnant stomach and showed a polypoid lesion resembling a spring coil (A). Microscopically, the intestinal mucosa, submucosa, and muscularis propria were completely convered and foreign body granulomatous reaction with suture materials was observed in the center of the leading point (B).
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Ischemic and necrotic changes were not found (Fig. 4).