Advanced Gastric Carcinoma within "Upside-down-stomach" due to Mixed Esophageal Hiatal Hernia -Report of a Case-

Masanori Matsuda, Takuma Aikawa, Takayoshi Sekikawa, Kazuhiro Karikomi, Hidehiko Iizuka, Hideki Fujii, Yoshiro Matsumoto

First Department of Surgery, Yamanashi Medical University

A 78-year-old woman was admitted to our hospital because of abdominal fullness. A chest X-ray film showed several air-fluid levels in the mediastinum. An upper gastrointestinal series showed an "upside-down-stomach" with a mixed esophageal hiatal hernia and was located in the mediastinum. There was a filling defect on the middle gastric body. Gastrofiberscopy showed a deformed stomach with a type 3 lesion on the middle gastric body. Histological examination of the biopsy samples from the lesion revealed signet ring cell carcinoma. A total gastrectomy with D1 lymph-node dissection and repair of the esophageal hiatus were performed. The resected specimen showed two elevated lesions, one on the middle gastric body and the other on the antrum of the stomach. Histologically, both tumors showed poorly differentiated adenocarcinoma infiltrating the subserosal layer and these tumors were connected submucosally by cancer cells. There were metastases in the group 2 lymph nodes. The patient died of obstructive jaundice 17 months after the operation. The association between the gastric carcinogenesis and the hiatal hernia is controversial. This is the second case of resected gastric cancer within "upside-down-stomach" in Japan.

Key words
upside-down-stomach, mixed hiatal hernia, advanced gastric cancer

Reprint requests
Masanori Matsuda First Department of Surgery, Yamanashi Medical University
Tamaho, Nakakoma-gun, Yamanashi, 409-38, JAPAN

Accepted
January 8, 1997

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