A Case of Perforation in Wide-Spread and Superficial-Invading Early Gastric Cancer

Naoto Ueyama, Tadashi Kagoshima, Kazuo Okuti, Takeshi Nakao, Saburou Sadou¹⁾, Masayuki Nakagawa, Takamasa Watanabe, Saburou Hongou, Hiroshige Nakano²⁾

Nara Emergency and Critical Care Medical Center
¹⁾Department of Surgery, Nara Prefectural Nara Hospital
²⁾First Department of Surgery, Nara Medical University

A 73-year-old man was admitted to our center for panperitonitis, and underwent total gastrectomy with radical lymph-node (L.N) dissection due to panperitonitis caused by a perforated gastric cancer. Macroscopic observation and pathological examination of the resected specimen showed wide-spread, superficial-invading early gastric cancer over the area extending from the anterior wall through the lesser curvature to the posterior wall of the cardia with complicating perforated IIc+III type and III type; the former in the anterior wall and the latter in the posterior wall of the cardia. Almost all the cancer invaded only the mucosal layer, and the other cancer around ulcer of the anterior wall invaded the submucosal layer. Pathological findings showed that small arteries in the submucosal layer were stenotic with arteriosclerotic changes and in particular around the perforated lesion, but into recanalization (was recanalized again) after obstruction by a thrombus. Why the perforation occurred in this case is unknown, but such ischemic changes in small arteries and the weakning of necrotic ulcer base due to Candida infection may be responsible for it. There were pathologically neither peritoneal dissemination nor regional L.N. metastasis. The patient was successfully treated with intensive care in spite of complicating pneumonia and general Candida infection, and then completely recovered and was discharged. Cases of perforation of early gastric cancer is rare, so it is important that radical gastrectomy, if the condition requries it, is performed for perforated early gastric cancer even though it is relatively rare.

Key words
perforation of early gastric cancer, peritonitis, multiform type of early gastric cascer

Reprint requests
Naoto Ueyama Nara Emergency and Critical Care Medical Center
1-30-1 Heramatsu, Nara, 631-0846 JAPAN

Accepted
October 1, 1997

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