Abstract
An 87-year-old woman complaining of appetite loss and general fatigue was strongly suspected to have gastric cancer and was referred to our hospital. A chest X-ray film demonstrated stomach bubble which was identical with the cardiac shadow. Gastric fluoroscopic study revealed that the entire stomach from the cardiac part to the pylorus had deviated to the posterior mediastinum, showing the upside down stomach. Gastric endoscopy showed an ulcerative lesion from the angular notch to the pyloric antrum, a biopsy of which showed poorly differentiated adenocarcinoma. Advanced gastric cancer associated with the upside down stomach was diagnosed, and distal gastrectomy + resection of the hiatal hernia sac were performed under laparotomy. Reconstruction was done by means of Roux-en-Y method. The remnant stomach was sutured and fixed to the crus of the diaphragm so as not to be impacted again into the thoracic cavity. The final histopathological diagnosis was pT4apN3aM0, INFb, ly3, v2, and Stage IIIC. The postoperative course was uneventful. No regurgiatation symptoms have been noted.
We would have to consider different reconstruction methods and procedures to prevent regurgitation for different cases of gastric cancer associated with the upside down stomach.
