Abstract
A 73-year-old man admitted for sudden abdominal pain in August 2004 was found to have free air and ascites in abdominal computed tomography. Upper gastrointestinal endoscopic examination showed a large perforatedv gastric ulcer necessitating emergency surgery. At laparotomy, the anterior wall of the stomach was perforated by the ulcer, which extended to the lesser curvature and posterior wall, penetrating into the pancreatic body in the posterior gastric wall. Distal gastrectomy was conducted followed by Roux-en-Y reconstruction. Resected specimens of the stomach showed a perforated gastric ulcer 70×43mm from the anterior to posterior wall, centering on the lesser curvature. Pathologically, type III of early gastric cancer was detected in the distal edge of the perforated ulcer. Gastric carcinoma was histologically diagnosed as poorly differentiated adenocarcinoma limited in the mucosal layer. The final diagnosis was T1, N0, H0, P0, CY0, M0, stage IA. Helicobacter pylori was also detected. The postoperative course was uneventful and the man was discharged on postoperative day 53. Perforation of early gastric cancer is relatively rare, and the present case is rare from the point of extensive ulcer formation with perforation and penetration into the pancreas.
