[A case of perforated gastric cancer in which resection for elimination was possible S-1/CDDP combined chemotherapy for peritonitis carcinomatosa].
The present patient was a 66-year-old male with sudden upper abdominal pain. The patient was diagnosed with perforated peritonitis at another hospital, and an emergency laparotomy was performed to confirm upper gastrointestinal tract perforation. A perforated lesion of approximately 1 cm in diameter was found on the anterior wall at the gastric upper body. The area surrounding the lesion was tumor-like. Malignancy was suspected; however, considering the patient's general status, greater omentum grafts were opted for. The patient was diagnosed with typeIII gastric cancer by gastroendoscopy postoperatively. A second surgery was performed after one month, but during laparotomy peritonitis carcinomatosa and metastastic nodules were found around the abdominal aorta. S-1/CDDP therapy was started on the 14th day after second surgery. After three courses of treatment, the tumor was found to have smoothened, wall consolidation was improved, and a third surgery was performed. During laparotomy, there were no other medical findings that raised suspicion of peritoneal dissemination or liver metastasis. It was concluded that radical surgery was possible, and distal gastrectomy(D2+a)was performed. Pathological examination revealed that poorly differentiated adenocarcinoma. The lower and muscle layers of the serous membrane and nodules around the abdominal aorta showed the disappearance of cancer cells. But the peritonitis carcinomatosa during second surgery had pathologically / changed the fibrosis tissue at the third surgery.
Sugimoto
Takemi
T
Dept. of Surgery, Hyogo Prefectural Kaibara Hospital, Japan.
Itakura
Takayasu
T
Uesaka
Kunio
K
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D004338:Drug Combinations; D005773:Gastroscopy; D006801:Humans; D008297:Male; D010094:Oxonic Acid / Q000627:therapeutic use*; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D005641:Tegafur / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D002945:Cisplatin