A Case of Gastric Necrosis with Gastric Cancer

Toshihiro Murata, Hirokazu Uetsuka, Masashi Uda, Osamu Kawamata, Hajime Nakai and Tamotsu Ohta

Department of Surgery, Onomichi Municipal Hospital

A 59-year-old man admitted for abdominal pain and tenderness and muscular defense in the upper abdomen, was found in blood examination to have an increased inflammation reaction, a liver and renal function disorder, and increased creatine kinase. Computed tomography showed significant thickening of the gastric wall and slight abdominal dropsy. Based on a clinical diagnosis of peritonitis, we undertook exploratory laparoscopy. The presence of hemoperitoneum and ischemic change in the gastric wall necessitated gastrointestinal endoscopy, which in turn showed defluxion of the gastric mucosa, ulceration and necrotic change. Based on a diagnosis of gastric necrosis, we conducted total gastrectomy. Pathological examination showed moderately differentiated adenocarcinoma and tumour invasion to the muscularis propria. Neutrophilic leukocytes were seen in all layers and formed an abscess. Transmural necrosis was seen in part of stomach, presumably due to infection from the cancerous ulcer.

Key words
gastric necrosis, gastric cancer, laparoscopy

Reprint requests
Toshihiro Murata Department of Surgery, Onomichi Municipal Hospital
3-1170-177 Sintakayama, Onomichi, 722-8503 JAPAN

Accepted
December 19, 2007

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