A case of perforated gastric cancer treated with an emergency laparoscopic occulusion followed by radical resection Nobuyasu HAYASHI 1 , Yasunori HASUIKE 1 , Shin-ichi FUJIWARA 1 , Nariaki FUKUCHI 1 , Masaki TUJIE 1 , Tetsuya YOSHIDA 1 1Department of Surgery, Hyogo Prefectural Nishinomiya Hospital Keyword: 胃癌 , 穿孔 , 腹腔鏡下大網充塡術 pp.61-65
Published Date 2007/2/15
DOI https://doi.org/10.11477/mf.4426100012
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 Patients with perforated gastric cancer who undergo emergency gastrectomy have a poor prognosis due to incomplete resection. This is partly because perforated gastric cancer is rare and it is generally not diagnosed preoperatively or intraoperatively. We present a 65-year-old man with perforated gastric cancer who underwent an emergency laparoscopic occulusion by omental plug, later followed by radical operation. The patient had a chronic gastric ulcer and was admitted to the hospital because of severe epigastralgia. The diagnosis of upper gastrointestinal perforation was made by abdominal computed tomography which demonstrated free air and ascites in the right lateral abdomen. Beacause malignancy was strongly suspected during laparoscopic examination only omentoplasty was performed laparoscopically. Postoperative examination revealed a Borrmann type 3 advanced gastric cancer at the lower portion of the stomach with a solitary metastasis in the liver. We perfomed distal gastrectomy with lymph node resection and partial hepatectomy. The patient was discharged on the 17 th postoperative day. At 15-months follow-up, the patient is alive and free of recurrent disease.

 The laparoscopic repair with an omental patch for perforated gastric cancer might be useful in view of reduced morbidity and decreased adhesion, as well as intraoperative precise evaluation of the abdomen. Emergent laproscopic operation might contribute to the upgrade of survival for perforated gastric cancer, enabling the surgeons to perform complete resection following exact diagnosis of gastric cancer after laparoscopic surgery.

Copyright © 2007, JAPAN SOCIETY FOR ENDOSCOPIC SURGERY All rights reserved.


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