A rare case of digestive tract hemorrhage of extraluminal origin after total gastrectomy

: The authors report on a case of digestive bleeding (melaena and enterorrhagia) in a patient undergoing total gastrectomy for gastric cancer and later splenectomy for subcapsular haematoma in a different hospital. The source of bleeding was not intraluminal; the bleeding arose from double erosion of the gastroduodenal artery in the tract above the anterior surface of the pancreas, close to the dehiscent duodenal stump. The blood flowed mainly into the enteric district through the open stump thus causing the clinical signs described. The diagnosis was made during an emergency surgical operation for haemorrhagic shock. The patient underwent haemostasis with two stitches on the gastroduodenal artery, external drainage of the duodenum with a Petzer tube, laparostomy of the infected area and ileostomy. After three months he had completely recovered.