Megaloblastic anemia following gastrectomy is due to the total absence or inadequate secretion of intrinsic factor and is manifested by megalobastic changes in bone marrow, blood cells, and other proliferative cells. In Korea, detailed description and precise analyses of the cases of megaloblastic anemia following gastrectomy are relatively rare in contrast to the potential of its incidence from gastrectomy due to many causes or to the importance of its clinical significance. Here, we present the case of a 51-year old man who had undergone a total gastrectomy with esophagojejunostomy and incidental splenectomy due to early gastric cancer and developed megalobastic anemla 7 years after surgery. After gradual improvement of clinical and hematologic features with treatment of parenteral vltamin B_l2, he was followed-up with vitamin B12 maintenance therapy.