Case Report Late Onset Remnant Gastric Cancer with Afferent Loop Syndrome 47 Years after Billroth II Surgery Memduh Gahin, 1 Bahattin Ozlu, 2 Kivilcim Eren Erdogan, 3 and Tahsin Colak 4 1 Gastroenterology Department, Endoscopy Unit, Mersin State Hospital, Nusratiye Mahallesi, 33050 Mersin, Turkey 2 Gastrointestinal Surgery Department, Mersin State Hospital, 33050 Mersin, Turkey 3 Pathology Department, Mersin State Hospital, 33050 Mersin, Turkey 4 General Surgery Department, Mersin University, 33050 Mersin, Turkey Correspondence should be addressed to Memduh s ¸ahin; memsahinsahin@hotmail.com Received 31 January 2015; Revised 14 April 2015; Accepted 23 April 2015 Academic Editor: Alexander R. Novotny Copyright © 2015 Memduh s ¸ahin et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Remnant gastric cancer is a rare clinical entity. Herein we describe a patient with remnant gastric cancer that presented with aferent loop syndrome 47 years afer Billroth II surgery. Symptoms of serious bilious vomiting were an indication to perform early endoscopic diagnosis, followed by complete gastric resection. In particular, patients that have undergone surgery due to benign indications should be examined endoscopically, even a long time afer initial surgery. 1. Introduction Remnant gastric cancer (RGC) is a rare clinical entity that can occur following distal gastrectomy, especially along the suture line or in the anastomotic region [1]. Te occurrence of RGC in gastric cancer patients following distal gastrectomy was reported to be approximately 1%-2% in a Japanese study [2]. RGC has similar metastatic characteristics and surgical treatment procedures as gastric cancer [1]. RGC is generally diagnosed at an advanced stage, with a low chance of cure, high rate of lymph node metastasis, and poor prognosis [3]. Recent advances in diagnosis and treatment have increased the rate of detection of RGC following distal gastrectomy [4]. Te standard surgery for RGC is complete gastric resection and lymph node dissection. It was reported that as time afer gastric surgery increases, the risk of gastric adenocarcinoma increases. Approximately 70%–75% of gastric remnant carci- nomas are resectable and 60%–70% are removed for complete cure. Although adjuvant chemotherapy and radiotherapy have been suggested, their efcacy remains unclear [5]. Aferent loop obstruction is a rare entity following Bill- roth II reconstruction and subtotal gastrectomy [6]. Te onset can present as acute or late and can be accompanied by peritonitis and/or perforation, which can result in death. Te incidence of aferent loop obstruction following Billroth II surgery is 0.3%–1%. Herein we describe a patient with RGC and aferent loop syndrome that presented 47 years afer Billroth II surgery. 2. Case A 70-year-old Caucasian male presented to the Mersin State Hospital, Department of Gastroenterology, Mersin, Turkey, with vomiting and abdominal pain. Medical history showed weight loss up to 10 kg during the previous 3 months due to frequent bilious vomiting and colic abdominal pain, which restricted oral intake. Te patient had undergone gastric surgery (distal gastrectomy and Billroth II reconstruction) 47 years earlier (1967) because of a peptic ulcer. Te patient had a negative history of constipation and diarrhea. Te patient had previously presented to numerous other medical centers with the same symptoms and had been unsuccessfully treated with proton pump inhibitors (PPIs) and antiacid agents. Physical examination showed a pale tongue and epigastric tenderness. He also had a cachectic body composition. Laboratory fnd- ings showed moderate anemia (hemoglobin: 9.89 g dL -1 ) and low serum albumin (3.31 g dL -1 ) and sodium (133 g dL -1 ), indicative of poor nutrition. Other biochemical parameters were in the normal range. Hindawi Publishing Corporation Case Reports in Surgery Volume 2015, Article ID 730897, 4 pages http://dx.doi.org/10.1155/2015/730897