A successfully treated case of type 4 cancer of the stomach with perforation and invasion to the transverse colon by primary resection of the stomach and the transverse colon

Abstract

A 56–year–old woman consulted a physician complaining of abdominal distension, and was diagnosed as having bowel obstruction. Endoscopic and histological examination revealed type 4 gastric cancer. In addition, advanced transverse colon cancer was suspected by colonoscopy. On the 9th hospital day, severe abdominal pain appeared and the patient was diagnosed as having generalized peritonitis due to perforation of the digestive tract. At laparotomy, the patients was diagnosed as having type 4 cancer of the stomach with perforation at the anterior wall of the gastric body and invasion to the transverse colon. Total gastrectomy with transverse colon resection was conducted. Histopathologically, the tumor was poorly differentiated adenocarcinoma with invasion to the transverse colon, and the final staging of the gastric cancer was T4, N1, H0, P1, CY0, M0, Stage IV, and the curability of the operation was B. Although the patient suffered subphrenic abscess and pancreatic fistula after surgery, she recovered. The patient started to take diet on the 36th postoperative day (POD52), and was discharged on POD52 after an adjuvant chemotherapy. Type 4 cancer of the stomach with perforation is rare. Moreover, the reports of primary resection of the stomach including other involved organs are very rare. The patients with type 4 cancer of the stomach with perforation should be treated considering patients general condition, histological confirmation of the carcinoma, curability, prognosis and quality of life.