A Case of Lumbo-Peritoneal Shunt for Meningeal Carcinomatosis from Gastric Cancer

Michio Kuwahara, Hidekazu Ezaki*, Ryuta Nishitai*, Shoji Tsunekawa*, Yoshirou Taki* and Jyun Kawai**

Department of Surgery, Japanese Red Cross Hospital Wakayama Medical Center
Department of Surgery* and Department of Pathology**, Kansai Denryoku Hospital

A 62-year-old man undergoing endoscopic mucosal resection (EMR) for gastric adenoma followed by annual upper gastrointestinal endoscopy was found in a blood test to have CEA of 75 ng/dl. A diagnosis of gastric cancer based on signet ring cell carcinoma detected by an EMR scar biopsy and scheduled surgery was halted, however, when he suddenly developed cervical pain, shoulder pain, and headache, necessitating emergency surgery following a complex epileptic seizure. Spinal fluid test on admission showed elevated intrathecal pressure higher than exceeding 35 cmH2O. Decompression dramatically relieved symptoms. Signet ring cells were detected in the spinal fluid, yielding a diagnosed of carcinomatous meningitis with increased intracranial pressure, necessitating subdural-peritoneal lumbar shunting. Following chemotherapy with TS-1 and CDDP, he returned to regular life. About 2 months after discharge, however, he was found lying in the bathroom at 06: 00 and taken to hospital by ambulance. He had reportedly taken his usual morning and evening walk the day before admission. He did not regain consciousness and died 1 week after rehospitalization. His intrathecal pressure was normal and the shunt tube presented no apparent problem.

Key words
meningeal carcinomatosis, gastric carcinoma, lumbo-peritoneal shunt

Reprint requests
Michio Kuwahara Department of Surgery, Japanese Red Cross Society Wakayama Medical Center
4-20 Komatsubara-tori, Wakayama, 640-8558 JAPAN

Accepted
February 18, 2009

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