Esophago-jejuno-duodenal anastomoses with an ultra-short duodenum

Reconstruction following total gastrectomy usually requires one of the various methods of esophagojejunal anastomosis. We present herein the case of a 78-year-old woman with gastric carcinoma involving the adjacent organs for which resection of the whole stomach, distal pancreas, transverse colon, and distal duodenum was performed. Reconstruction was carried out with an esophagojejunostomy, followed by a side-to-side anastomosis between the raised jejunal limb and the residual short duodenum. Her postoperative course was uneventful and she was able to lead a relatively comfortable life at home until she died after tumor recurrence caused GI bleeding 1 year postoperatively. This new modified Roux-en-Y with an ultra-short duodenum can be applied for such contiguously invasive gastric carcinoma to achieve a better quality of life, when conventional reconstruction techniques after total gastrectomy are not indicated.