Gastric Stump Cancer

The gastric remnant, or stump, is the portion of stomach remaining following gastric surgery and is a common location for the development of carcinoma. Although classically described in patients who underwent partial gastrectomy for peptic ulcer disease, gastric stump cancer is a potential complication with any gastric surgery. Post-gastrectomy patients are 2-6 times more likely to develop a gastric carcinoma than non-operated patients.

Although the pathogenesis is not well understood, it is presumed that reflux of bile and pancreatic alkaline secretions into the gastric remnant promote chronic atrophic gastritis and other premalignant mucosal changes. The condition is compounded in post-vagatomy and partial gastrectomy patients due to a lack of gastric acid production, thus refluxed materials are no longer buffered. Neoplastic transformation and infiltration are limited to the mucosa of the gastric border, preferentially occurring at the anastomosis. The jejunal mucosa is typically spared although deeper layers of the jejunum may be invaded. Gastric stump cancers have the same pathophysiology as gastric carcinomas occurring in non-operated tissue (see Gastric Carcinoma section).

Radiographic Findings: UGIS or CT

• Irregular filling defects. (Perianastomotic benign hypertrophy of the mucosal folds may occasionally cause filling defects that are difficult to distinguish from tumor.)

• Narrowing and wall rigidity at the anastomotic region or in the gastric remnant