A Case of Gastric Abscess Secondary to Primary Cancer of the Duodenal Bulb

Abstract

A case is presented of a female aged 78 whose chief complaints were pain in the right hypochondrium and fever (38.4°C) .
X-ray and endoscopic examination of the stomach revealed a well differentiated adenocarcinoma of Borrmann's type 1 in the duodenal bulb and a large amount of pus excretion into the lumen from a fingertip-sized prominence on the anterior wall of middle portion of the gastric body. Klebsiella oxytoca and α-Streptococcus, resident microbes of the upper gastrointestinal tract, were detected from the pus. A CT scan of the abdomen suggested the formation of a mass in the duodenum involving the gallbladder and the porta hepatis, and the presence of an abscess on the anterior side of the mass linked to the anterior wall of the stomach.
An exploratory laparotomy revealed that direct infiltration of the tumor had resulted in a mass involving the duodenum, gallbladder, liver, transverse colon and the anterior wall of the stomach. Penetration into the stomach due to necrosis had caused retrograde infection which resulted in the abscess and excretion of pus into the stomach.
This is thought to be a very rare case because our review of the literature found no other reports of cases of abscess due to infiltration of primary duodenal cancer into the anterior wall of the stomach and penetration into the lumen.