title: Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection.
abstract: An 80-year-old man who had undergone distal gastrectomy and Billroth-II gastrojejunostomy 38 years previously, for a benign gastric ulcer, was diagnosed with remnant gastric cancer based on upper gastrointestinal endoscopy findings. He presented at our emergency department with acute-onset epigastric pain due to perforated remnant gastric cancer. Conservative medical management was selected, including nasogastric tube insertion, antibiotics, and proton pump inhibitors, because his peritonitis was limited to his epigastrium and his general condition was stable. Twenty-one days after the perforation occurred, curative total remnant gastrectomy and D2 lymphadenectomy were performed. Adhesion between the lateral segment of the liver and the dissected lesser curvature of the gastric remnant may have contributed to the peritonitis in this case, which was limited to the epigastrium. This is the first report of perforated remnant gastric cancer in which conservative treatment was effective prior to curative resection. The protocol reported here may be of use to other clinicians who may encounter this clinical entity in their practices.
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Ken
authors.identifier: 0000-0003-2754-7711
authors.initials: K
authors.lastname: Yuu
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawashima
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Toyoda
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okumura
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Kansuke
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Mizumura
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Maehira
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Imagawa
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Kameyama