A Senile Case with Gastric Cancer Perforation Saved by Emergency Palliative Resection Who Lived for 14 Months after the Surgery

Yoshihiro Moriwaki, Hiroshi Toyoda, Takayuki Kosuge and Mitsugi Sugiyama

Critical Care and Emergency Center, Yokohama City University Medical Center

We reported a patient with perforated gastric cancer who underwent palliative gastrectomy after resuscitation for cardiaopulmonary arrest (CPA) and was discharged without any neurological disturbance. The 81-year-old-man who had presented appetite loss, weight loss, right abdominal pain, and nausea 2 months ago, was transferred to our critical care center because of consciousness disturbance. He developed CPA 12 minutes after his arrival at the hospital and was resuscitated within 6 minutes. Some image findings such as contrast-enhanced CT showed intraperitoneal free air and irregularity of the antrum, suggestive of gastrointestinal perforation, peritonitis and the abdominal compartment syndrome. We managed the patient with primary fluid resuscitation for septic shock and performed emergency laparotomy with the object of decompression and control of the infectious focus. Intraoperatively, we found gastric cancer with serosal invasion in the lower anterior portion and peritoneal dissemination, and performed palliative gastrectomy with Roux-en-Y reconstruction (LCirc, type 3, pT3 (SE), sN3, sH0, sP1, fStage IV, ly3, v2, INFβ, tub2>por2). The postoperative course was uneventful. After 8 months, contrast-enhanced CT showed metastatic recurrence in the intraperitoneal lymph nodes, liver and lung. The patient died 14 months (407 days) after the operation.

Key words
perforation of gastric cancer, severe sepsis and septic shock, cardiopulmonary arrest

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
June 18, 2008

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