A case of protein-loosing gastroenteropathy caused by double gastric cancer

Abstract

An 80–year–old man was admitted to our hospital because of upper abdominal pain. Physical examination revealed mild edema of the extremities and blood biochemical study revealed rerious hypoproteinemia (serum total protein : 4.9g/dl, serum albumin : 1.8g/dl). Gastrofiberscopy showed type 1 gastric cancer on the upper gastric body and type 2 gastric cancer on the pyloric part. Fecal excretion and clearance of alpa–1 antitripsin were high. Preoperative hyperalimentation and administration of an amino acid drug failed to increase serum protein level. He was diagnosed as having protein–loosing gastroenteropathy caused by gastric cancer. He underwent total gastrectomy and D2 lymph node dissection. The type 1 tumor, 10cm in diameter, showed cauliflower like form, and it was diagnosed as moderately differentiated adenocarcinoma with the depth of invasion of sm. The type 2 tumor, 9cm in diameter, was diagnosed as papillary adenocarcinoma and the depth of invasion was se. Postoperative course was uneventful and hypoproteinemia improved remarkably to TP of 6.8g/dl and Alb of 2.9g/dl on the postoperative day 16. If protein–loosing gastroenteropathy caused by malignant tumors are suspected like in this case, early surgery for the primary foci is the securest treatment because preoperative alimentary mangement is often difficult to improve the condition.