Abstract
A 62-year-old man who had been followed for a gastric submucosal tumor for these six years at a neighboring hospital was referred to our hospital because the tumor showed an increasing tendency. We confirmed a 25-mm submucosal tumor showing an intratubal growth at the anterior wall of the fornix of stomach (oral tumor) and, on the anal side of the tumor, another 15-mm submucosal tumor showing an extratubal growth (anal tumor). These two tumors were about 4 cm distant away. We resected the entire layers including the oral tumor by oral endoscopic procedures after suturing sero-muscular layers, and performed laparoscopic full thickness resection for the anal tumor after dissecting sero-muscular layer. As for the oral tumor, after dissecting the submucosal layer by ESD procedures, the dissected sero-mucosal layer was sutured by laparoscopic procedures, and the entire layers including the oral tumor was resected by oral endoscopic procedures. As for the anal tumor, the serosa and muscle layer surrounding the anal tumor was incised whole-circumferentially, and the tumor was fully pulled to the abdominal cavity side and was resected by linear stapler. We present our attempt to minimize the resection area and the deformity of the stomach for removal of two gastrointestinal stromal tumors of the gastric fornix which existed with the distance of about 4 cm.
