Abstract
An 86-year-old man presented to a hospital with vomiting. An endoscopic examination showed type 3 gastric cancer with pylorus stenosis. Because peritoneal carcinomatosa was suspected from an abdominal CT scan, an endoscopy digestive tract stent placement was performed. Abdominal pain appeared 4 days after the stenting. An abdominal CT scan revealed a large amount of free air and ascites mainly in the upper abdominal cavity, so he was transferred to our hospital under the suspected diagnosis of upper gastrointestinal perforation. On the same day, an emergency operation was carried out. A large amount of purulent ascites, a huge tumor at the gastric antrum, peritoneal dissemination, and a perforation at the duodenal bulbus were confirmed. A diagnosis of iatrogenic duodenal perforation due to the physical contact of the distal end of the stent was made, so we removed the stent, sutured the perforated site, performed a gastro-jejunal bypass, washed and carried out drainage inside the abdominal cavity. Endoscopic stent placement is one of palliative treatments for unresectable malignant digestive stenosis. Although it is minimally invasive compared with a digestive bypass operation and is equal to the digestive bypass operation in terms of its effect of the improvement of the patient’s quality of life, we must be careful to avoid fatal complications including perforation and bleeding.
