Rationale:Gastric stump carcinoma (GSC) is very exceptional and little known after Whipple procedure, and its diagnosis and treatment are extremely difficult to handle.Patient concerns:The patient, a 68-year-old man, visited our hospital’s General surgery outpatient clinic complaining of upper abdominal pain that had been bothering him for half a month. The endoscopy revealed lesions in the stomach residual, and the pathological results suggested adenocarcinoma. The patient underwent Whipple procedure for periampullary adenocarcinoma in the 4th year ago.Diagnoses:The final diagnosis was gastric adenocarcinoma and its pathological stage was Ⅱ A (T3N0M0).Interventions:The patient underwent stump gastrectomy and end-to-side esophagojejunostomy (Roux-en-Y reconstruction).Outcomes:The operation went smoothly and the patient recovered well with only mild bloating and nausea, and the symptoms completely disappeared during the hospital stay.Lessons:The development of GSC several years after Whipple procedure is uncommon. This is the first case from China that has received international attention. Early diagnosis is crucial. Surgery is considered to be the most effective treatment for GSC after Whipple procedure if long-term survival is possible and surgical risks are controllable.