An 81-year-old woman developed multiple organ failure resulting from hemorrhagic shock caused by upper gastrointestinal bleeding. Following intensive care that improved her general status, upper gastrointestinal endoscopy was performed that confirmed the presence of an elevated lesion in the pylorus, and the biopsy result was group V. Since various imaging tests confirmed volvulus of the stomach with prolapse into the thoracic cavity, early gastric cancer occurring concomitantly with an upside-down stomach was diagnosed, and laparoscopic distal gastrectomy was performed. Roux-en-Y reconstruction was selected for reconstruction due to concerns regarding the postoperative onset of reflux esophagitis. The final histopathological diagnosis was type 0-IIc+IIa pT1apN0M0, ly0, v0, Stage IA. Laparoscopic surgery appears to be a useful option for early gastric cancer in patients with an upside-down stomach.
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