A Case of Gastric Cancer Complicated with Leriche Syndrome

Abstract

The patient was a man in his seventies who was receiving outpatienttreatment for atrial fibrillation and Lericheʼs syndrome at thecardiology department of our hospital. Upper gastrointestinal endoscopy conducted to assess anemia revealed a protruded lesionwith ulceration on the posterior wall of the gastric antrum. Contrast-enhanced computed tomography of the abdomen revealed obstruction of the abdominal aorta extending from the vicinity of the renal artery branch up to the bilateral femoral arteries. Blood flow to the legs was delineated with collateral circulation via the epigastric artery and the artery in the rectus abdominis muscle. While planning for surgery, the care required to not impair the collateral blood flow on the abdominal side during surgery was taken into account. This planning included intraoperative observation of the dorsal artery of the foot, protective usage of retractors, and drain placement via the midline wound. Thus, distal gastrectomy was performed without damaging the collateral circulation. In Lericheʼs syndrome, the collateral circulation passes the abdominal wall, which plays a significant role during abdominal surgery. Therefore, the surgery must be thoroughly planned so that it can be safely and easily completed, which will also help prevent severe complications.