Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection

Yuu, Ken; Kawashima, Hiroshi; Toyoda, Sho; Okumura, Satoshi; Yamamoto, Kansuke; Mizumura, Naoto; Ito, Aya; Maehira, Hiromitsu; Imagawa, Atsuo; Ogawa, Michio; Kawasaki, Masayasu; Kameyama, Masao

doi:10.1155/2016/4091952

Cited by 3 publications

(5 citation statements)

References 17 publications

(21 reference statements)

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“…[ 17 , 18 ] In individual cases with localized peritonitis and a clinically stable condition, conservative treatment of the perforation might be successful. [ 19 ] In the described case, the patient did not present with any clinical signs of gastric perforation. The perforation was incidentally diagnosed 2 weeks after ablation.…”

Section: Discussionmentioning

confidence: 72%

“…However, several cases have been described where gastric perforation at early diagnosis could be treated endoscopically and emergency surgery could be avoided [17,18] . In individual cases with localized peritonitis and a clinically stable condition, conservative treatment of the perforation might be successful [19] . In the described case, the patient did not present with any clinical signs of gastric perforation.…”

Section: Discussionmentioning

confidence: 83%

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Conservative treatment of gastric perforation after microwave ablation of a hepatocellular carcinoma

Roller

Zimmer²,

Bücker

et al. 2022

Medicine

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Rationale:Microwave ablation (MWA) has been proven to be an efficient and safe method for local tumor control of liver tumors. Reported complications are rare, but include liver abscess, hematoma, pleural effusion, and occasional thermal injury of the adjacent colon. Intestinal perforation usually requires immediate surgical treatment to prevent generalized peritonitis and sepsis.Patient concerns and diagnosis:Herein, we describe a case of gastric perforation following percutaneous MWA for hepatocellular carcinoma as a bridging therapy prior to liver transplantation.Interventions:Due to the clinical condition of the patient, conservative treatment was considered sufficient. Nine months after MWA, successful liver transplantation followed. Intraoperative findings revealed a scar in the gastric wall with tight adhesions to the liver, requiring adhesiolysis and subsequent suturing. Postoperative recovery was uneventful.Outcome:At present, the patient is doing well. No further gastrointestinal events occurred.Lesson:To our knowledge, this is the first report of such a complication occurring after MWA. Moreover, in this case, the gastric perforation could be treated conservatively.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 83%

Conservative treatment of gastric perforation after microwave ablation of a hepatocellular carcinoma

Roller

Zimmer²,

Bücker

et al. 2022

Medicine

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“…Among the 42 patients, 20 patients had liver involvement with a perforated duodenal ulcer and 22 patients had liver involvement with a perforated gastric ulcer. Among the 23 cases with known ulcer histology, 2 were malignant and were adenocarcinomas in the gastric remnant, 3 , 4 and the 21 remaining ulcers (11 duodenal and 10 gastric ulcers) were confirmed as histologically benign. However, the frequency of malignant ulcers was not different between duodenal and gastric ulcers ( p = 0.48).…”

Section: Resultsmentioning

confidence: 98%

“… 11 Thirteen cases were diagnosed by the direct observation of an ulcer that perforated into the liver during surgery. 4 , 8 , 12 , 21 , 24 , 26 , 27 , 29 , 33 , 34 , 39 , 40 …”

Section: Resultsmentioning

confidence: 99%

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review

Jiao¹,

Zhang²

2021

Journal of Clinical and Translational Pathology

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Background and Objective: Liver penetration by a confined perforation of peptic ulcer is a rare but severe event. Its clinical and pathological features are unclear. Methods: In total, 41 qualified English publications were identified using the PubMed database and one in-house case. Results: Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Among the 23 cases of known ulcer histology, 2 ulcers were malignant and were adenocarcinomas in the gastric remnant and the remaining 21 ulcers were confirmed as histologically benign (for frequency of malignancy in duodenal versus gastric ulcers, p = 0.48). The presence of hepatocytes was the clue of diagnosis for 19 cases. The median ages of the patients were 64.5 years (95% Confidence Intervals [CI] 53.40-71.90) for duodenal ulcer and 65.5 years (95% CI: 59.23-70.95) for gastric ulcer, respectively. The male to female ratio was 1.5:1 for duodenal ulcers and 2:1 for gastric ulcers. Patients with liver involvement of a perforated gastric ulcer were more likely to have a larger ulcer (median largest dimension, 4.75 cm versus 2.5 cm, p = 0.014). Female patients with liver involvement of a gastric ulcer were older than male patients (median age 72 versus 60 years, p = 0.045). There were no differences in gender, region (Asia, Europe, America versus others), use of nonsteroidal anti-inflammatory drugs (n = 15), H. Pylori positivity (n = 10), possible history of peptic ulcer disease (n = 19) or mortality (n = 32) between duodenal and gastric ulcers. Conclusions: Careful histologic examination, clinicopathological correlation, and immunohistochemistry are critical to establish the diagnosis and avoid misdiagnosing liver involvement as malignancy.

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“…In this case, we performed conservative treatment for early-stage gastric cancer and then performed twostage radical surgery for gastric cancer. There has been only one case reported in the English literature [12], in which a curative resection was performed after conservative treatment for gastric cancer. The advantages of conservative treatment are that it is less invasive if conservative treatment is successful; it is a two-stage treatment, which allows diagnosis of gastric cancer and accurate evaluation of the disease status by endoscopy and CT scan after conservative treatment; and accurate evaluation of comorbidities and systemic condition is possible by waiting for improvement in the peritonitis state and systemic condition.…”

Section: Discussionmentioning

confidence: 99%

Curative resection following conservative treatment for perforated early gastric cancer: A case report

Yoshizawa¹,

Sugiyama²,

Koyama³

et al. 2023

Preprint

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Background: Gastric perforation is a relatively rare complication of gastric cancer. Malignant gastric perforation is often a manifestation of advanced cancer with serosal invasion and lymph node metastasis; thus, gastric cancer rarely perforates at an early stage. Herein, we describe a case of gastric perforation, which was treated conservatively; later, the patient was diagnosed with an extremely rare early-stage gastric cancer and underwent radical surgery in two stages. Case presentation: An 81-year-old woman was referred to our hospital for breathlessness. Abdominal contrast-enhanced computed tomography (CT) revealed gastric perforation and perforated peritonitis. She was hospitalized, and conservative treatment was initiated; upper gastrointestinal endoscopy was performed on the 14th day after admission. Gastric ulcer scars were observed in the anterior wall of the stomach; biopsy from around the ulcer showed group V (moderately-well differentiated adenocarcinoma). She was diagnosed with gastric perforation due to early gastric cancer. Abdominal CT revealed no findings suggestive of liver, lung, or para-aortic lymph node metastasis, and a radical gastrectomy with lymph node dissection was performed 32 days after onset. Microscopic findings revealed that the cancer cells proliferated to the regenerated mucosa of ulcer scars and infiltrated into scar tissue equivalent to submucosal tissue (T1b). The gastric cancer was staged as T1bN0M0, stage IA. The patient has been reported healthy without any evidence of gastric cancer recurrence for the past 48 months. Conclusions: Treatment of gastric cancer perforation includes first-stage surgery and second-stage surgery after conservative therapy and closure of the omental patch or perforation site. Ensuring a balance between lifesaving and curability, while selecting surgical methods is necessary. Depending on the patient's general condition and degree of peritonitis, curatively resectable perforated gastric cancer, including early-stage gastric cancer, should be treated conservatively as in our case, or minimally invasively with an omental patch or perforation closure as surgery for gastric perforation. After evaluation of the patient's general condition and adequate assessment of the extent and progression of the gastric cancer, a two-stage gastrectomy with lymph node dissection was suitable and achieved an improved general condition, which may lead to a highly curative surgery and improve prognosis.

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Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection

Cited by 3 publications

References 17 publications

Conservative treatment of gastric perforation after microwave ablation of a hepatocellular carcinoma

Conservative treatment of gastric perforation after microwave ablation of a hepatocellular carcinoma

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review

Curative resection following conservative treatment for perforated early gastric cancer: A case report

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