title: A multidisciplinary approach to an unusual medical case of locally advanced gastric cancer: a case report.
abstract: BACKGROUND
  Complete abdominal wall infiltration with neoplastic gastrocutaneous fistula is an unexpected and out of the ordinary presentation of locally advanced gastric cancer. It is very rare to encounter case reports presenting diffuse abdominal wall invasion, but a complete parietal destruction is an exceptional event.
  
  
  METHODS
  Here we describe the case of an 81-year-old Caucasian woman presenting a carcinoma perforating her anterior gastric wall and infiltrating all layers of her abdominal wall. The gastric tumor infiltrated her transverse mesocolon, the rectus abdominis muscles bilaterally and overran them anteriorly, causing a large parietal deficit and a complete external fistula. Treatment consisted of a complex surgical procedure requiring general and reconstructive surgery cooperation in order to perform an en bloc gastric resection including colon and abdominal wall, followed by a parietal reconstruction through positioning of prosthesis and reverse abdominoplasty.
  
  
  CONCLUSIONS
  Clinical presentation, histology and therapeutic options are discussed. The importance of a multidisciplinary approach when encountering extremely rare clinical presentations is emphasized.
authors.affiliation: General Surgery, Department of Advanced Biomedical Science, University Federico II, Via S, Pansini 5, 80131 Naples, Italy. nicola.anita@tiscali.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Carlomagno
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Schonauer
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tammaro
authors.forename: Annalena
authors.initials: A
authors.lastname: Di Martino
authors.forename: Carmen
authors.initials: C
authors.lastname: Criscitiello
authors.forename: Michele L
authors.initials: ML
authors.lastname: Santangelo
mesh_terms: D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery; D058107:Abdominal Wound Closure Techniques; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000473:pathology / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D005747:Gastric Fistula / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009361:Neoplasm Invasiveness; D019651:Plastic Surgery Procedures; D017568:Rectus Abdominis / Q000601:surgery*; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D013536:Suture Techniques