Distal gastrectomy with lymph node dissection, a standard operative technique for gastric cancer treatment, is safely performed because the stomach has a rich vascular supply. Gastric remnant necrosis caused by cholesterol crystal embolization following distal gastrectomy has not been described previously. We report a case of gastric remnant necrosis in a patient with cholesterol crystal embolization. A 70-year-old man with a history of cholesterol crystal embolization presented to our surgery department with complaints of anorexia and dysphasia. He was diagnosed with gastric cancer invading the pyloric antrum and underwent distal gastrectomy with Billroth 2 reconstruction. On postoperative day 11, he developed abdominal pain without fever. Emergency laparotomy revealed that most parts of the remnant stomach were necrosed. Total gastrectomy with Roux-en-Y reconstruction and abscess drainage were performed. After surgery, anastomotic leakage occurred and was treated conservatively. However, the superior pancreaticoduodenal artery aneurysm suddenly ruptured and he expired. Gastric remnant necrosis after distal gastrectomy can be a gastrointestinal presentation of cholesterol crystal embolization. Perioperative/intraoperative risk assessments such as preventive total gastrectomy or intraoperative assessment with indocyanine green fluorescence angiography may be desirable to avoid this complication.

中文翻译：

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胃癌患者远端胃切除术后继发于胆固醇晶体栓塞的胃残余坏死：一例报告。

胃淋巴结清扫术是一种治疗胃癌的标准手术技术，可以安全地进行，因为胃的血管供应丰富。远端胃切除术后胆固醇晶体栓塞引起的胃残余坏死尚未见报道。我们报告胆固醇晶体栓塞患者胃残余坏死的情况。一位有胆固醇晶体栓塞病史的70岁男子因厌食和吞咽困难而出现在我们的外科部门。他被诊断出患有胃癌，侵犯了幽门腔，并通过Billroth 2重建术进行了远端胃切除术。术后第11天，他出现腹痛而没有发烧。紧急剖腹手术显示，大部分剩余胃部坏死。进行了全胃切除术，采用Roux-en-Y重建术和脓肿引流术。手术后，发生了吻合口漏并进行了保守治疗。但是，胰十二指肠上动脉瘤突然破裂而死亡。远端胃切除术后胃残余坏死可以是胆固醇晶体栓塞的胃肠道表现。为避免这种并发症，可能需要围手术期/术中风险评估，例如预防性全胃切除术或用吲哚菁绿色荧光血管造影术进行术中评估。远端胃切除术后胃残余坏死可以是胆固醇晶体栓塞的胃肠道表现。为避免这种并发症，可能需要围手术期/术中风险评估，例如预防性全胃切除术或用吲哚菁绿色荧光血管造影术进行术中评估。远端胃切除术后胃残余坏死可以是胆固醇晶体栓塞的胃肠道表现。为避免这种并发症，可能需要围手术期/术中风险评估，例如预防性全胃切除术或用吲哚菁绿色荧光血管造影术进行术中评估。