have associated the high erosion rate in their study to performing an endoscopic examination and use of the perigastric
technique on every patient who gained weight even if there were no symptoms.
Our patient benefited from a lymphadenectomy limited to the perigastric
nodes and those along the superior mesenteric vessels due to the particularities of lymphatic drainage in a gastrojejunal anastomosis.
The efficacy of MDCT in depicting the perigastric
vessel anatomy was investigated in several studies; authors have reported that MDCT is a useful and effective method for preoperative visualization of the perigastric
vessel anatomy [5-10].
Location Number of cases =40 Frequency Percent Mediastinum 16 40% Portahepatis 8 20% Para-aortic 8 20% Perigastric
5 12.5% Perirectal 2 5% Paraesophageal 1 2.5% Table 2: Size (cm) of the lymph nodes (n = 40).
The previously injected N-butyl-2-cyanoacrylate was still visible around the gastric cardia, in the perigastric
varices, and in the left adrenal vein.
lymph nodes, vessels, and adjacent viscera were excluded.
Lymph node stations (Japanese Classification of Gastric Carcinoma) No Definition 1 Right paracardial LNs, including those along the 1st branch of the ascending limb of the left gastric artery 2 Left paracardial LNs, including those along the oesophagocardiac branch of the left subphrenic artery 3a Lesser curvature LNs along the branches of the left gastric artery 3b Lesser curvature LNs along the 2nd branch and distal part of the right gastric artery 4sa Left greater curvature LNs along the short gastric arteries (perigastric
area) 4sb Left greater curvature LNs along the left gastroepiploic artery (perigastric
area) 4d Rt.
The rest of the examination of the perigastric
area was unremarkable.
CT of the abdomen and pelvis with contrast revealed multiple enlarged abdominal lymph nodes including perigastric
and pancreatic lymph nodes measuring up to 2.2 cm and retroperitoneal lymphadenopathy including a large retrocaval lymph node measuring up to 3.6 cm.
Axillary, laterocervical, supraclavear, mediastinal, celiac, crural, iliac, inguinal, paralumboaortic, and perigastric
lymph nodes were enlarged.
The band may be misplaced in the perigastric
fat or in the distal stomach.
Table 5 shows the distribution of SNs and their respective extraperigastric and perigastric
lymph node chains.