Abstract
A 50-year-old man was admitted for epigastralgia in September 1998, and was found to have free air on the plain abdominal X-ray. Upper gastrointestinal endoscopiy revealed an ulcer in the lower anterior wall of the stomach, with the endoscopic findings strongly suggestive of perforation of the gastric ulcer. Therefore an emergency operation was performed. At laparotomy, a perforation was identified on the greater curvature in the lower anterior wall of stomach. Extended gastrectomy was conducted followed by gastroduodenectomy. Specimens of the resected stomach showed a perforated gastric ulcer lesion measuring 2.5×1.8 cm in size on the greater curvature in the lower anterior wall. The perforation itself measured 0.3 cm in diameter and was present at the center of the gastric ulcer. The histologic findings in the surgical specimen were suggestive of moderately differentiated tubular adenovarcinoma invading the submucosal layer around the ulcer in the gastric wall. Postoperatively, no signs of recurrence were detected by regular imaging and blood tests. When laparoscopic cholecystectomy was performed for the diagnosis of cholelithiasis in September 1998, peritoneal dissemination was detected. Although chemotherapy was started following this surgery, the patient died of peritonitis carcinomatosa five years and eleven months after the gastrectomy. Perforation of early gastric cancer is rare, and a case like ours, who died of peritonitis carcinomatosa after gastrectomy is very rare.
