title: Perforated early gastric cancer: uncommon and easily missed a case report and review of literature.
abstract: Gastric carcinoma rarely presents as a perforation, but when it does, is perceived as advanced disease. The majority of such perforations are Stage III/IV disease. A T1 gastric carcinoma has never been reported to perforate spontaneously in English literature. We present a 56 year-old Chinese male who presented with a perforated gastric ulcer. Intra-operatively, there was no suspicion of malignancy. At operation, an open omental patch repair was performed. Post-operative endoscopy revealed a macroscopic Type 0~III tumour and from the ulcer edge biopsy was reported as adenocarcinoma. Subsequently, the patient underwent open subtotal gastrectomy and formal D2 lymphadenectomy. The final histopathology report confirms T1b N0 disease. The occurrence of a perforated early gastric cancer re-emphasises the need for vigilance, including intra-operative frozen section and/or biopsy, as well as routine post-operative endoscopy for all patients.
authors.affiliation: Department of Surgery, Singapore National University Hospital, Singapore.
authors.forename: Raymond Hon Giat
authors.initials: RH
authors.lastname: Lim
authors.forename: Clifton Ming
authors.initials: CM
authors.lastname: Tay
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wong
authors.forename: Choon Seng
authors.initials: CS
authors.lastname: Chong
authors.forename: Koji
authors.initials: K
authors.lastname: Kono
authors.forename: Jimmy Bok Yan
authors.initials: JB
authors.lastname: So
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
keywords: Early gastric cancer; General surgery; Peritonitis; Rupture spontaneous; Stomach neoplasms