A Case of Refractory Bleeding Marginal Ulcer of Billroth II Gastric Resection

A 63-year-old man, undergoing a distal gastric resection with Billroth II anastomosis for duodenal ulcer 20 years ago, was admitted to our hospital with the complaint of tarry stool. Initial treatments included intravenous fluid resuscitation, proton pump inhibitor, and nothing by mouth. Hemoglobin was 6.8g/dl, so patient received a transfusion of packed red blood cells. Emergent upper gastrointestinal endoscopy showed two marginal ulcers at the saddle area of the jejuna site, one was bleeding with exposed vessel, which was treated successfully by endoscopic hemostasis with hemoclips. The next day, the second endoscopy showed the same ulcer rebleeding, so hemoclips were applied again. On the third day after the hospital admission, the third endoscopy showed the other marginal ulcer bleeding with exposed vessel. So the third endoscopic hemostasis procedure with hemoclips was performed on the visible vessels at the base of the other ulcer to stop the bleeding. On the 10th day after the hospital admission he started feeding himself, discharged on the 17th day and received regular follow-up at the outpatient clinical department. Each value of blood gastorin, anti-Helicobacter pylori IgG antibody was in normal-range. CT angiography showed there was no large blood vessel near the marginal ulcer applied hemoclips. In this paper, we reported this difficult to be treated case and review the literature.