A Case of Rectal Metastasis from Gastric Cancer with Rectal Perforation

Tomotake Tabata, Masaki Fujimura, Isao Sato, Seiji Masuda, Yoshihide Chino, Atsushi Okita, Takafumi Yuuba, Minoru Iida, Ryouichi Arima¹⁾ and Yutaka Yonemura²⁾

Endoscopic Surgery Center, Daiichi-Towakai Hospital
Department of Pathology, Otemae Hospital¹⁾
NPO Organization to Support Peritoneal Dissemination Treatment²⁾

We report a very rare case of rectal metastasis with rectal perforation from gastric cancer. A 69-year-old man who underwent total gastrectomy for advanced type 4 gastric cancer in April 2007, followed by adjuvant chemotherapy without signs of recurrence, required emergency surgery in December 2008, due to panperitonitis. We found a full-circumferencial rectal stricture 3 cm orally from the anal verge and a mesorectal perforation 2 cm orally from the rectal stricture. To minimize operative stress, we resected the rectum at the site of the perforation and constructed a sigmoid colostomy. We found no peritoneal dissemination. Needle biopsy of the rectal stricture showed poorly differentiated adenocarcinoma, necessitating abdominoperineal resection in January 2009. Pathological findings showed that poorly differentiated adenocarcinoma had developed mainly in the submucosa, leaving the mucosal layer almost intact. The definitive diagnosis was rectal metastasis from gastric cancer. Not only is rectal metastasis from gastric cancer rare, our case is, to our knowledge, the first one of rectal metastasis from gastric cancer with rectal perforation reported in Japan.

Key words
rectal metastasis, gastric cancer, perforation

Reprint requests
Tomotake Tabata Endoscopic Surgery Center, Daiichi-Towakai Hospital
2-17 Miyano-cho, Takatsuki, 569-0081 JAPAN

Accepted
November 18, 2009

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