Abstract
A 73-year-old woman was admitted to our hospital because of severe epigastric pain following vomiting. A CT scan from the chest to abdomen and an esophagography revealed a rupture of the lower thoracic esophagus and pylorus stenosis associated with gastric cancer, and an emergency operation was carried out 4 hours after the onset of the symptoms. An about 2.5-cm long ruptured site was confirmed on the left side of the lower thoracic esophagus and it was closed by suture. Concomitantly, distal gastrectomy was performed for the treatment of pylorus stenosis caused by gastric cancer. On the 6th postoperative day, left thoracic empyema appeared. Irrigation and drainage were performed under a video-assisted thoracoscopic surgery (VATS). The final pathological diagnosis was gastric cancer in pStage IIIC (TNM classification : pT4aN3aM0). The postoperative course was relatively good, and the patient was discharged on the 56th hospital day. She has been free from any signs of recurrence, as of 8 months after the operation. Esophageal perforation caused by pylorus stenosis due to gastric cancer is very rare, with only eight cases being reported in the Japanese literature. Early surgical management should be considered against pylorus stenosis caused by gastric cancer with vomiting.
