Advanced gastric cancer linitis plastica presented with disseminated intravascular coagulation.
An old man was found unconscious; on admission found to have disseminated intravascular coagulation with concern of upper gastrointestinal bleed after he was found to have melena. Esophagogastroduodenoscopy on admission showed diffuse thickened gastric folds, and biopsy showed mucosal oedema. Bone marrow biopsy concerning for lymphoma was obtained showed adenocarcinoma. MRI of the abdomen was significant for diffuse gastric wall thickening. A repeat endoscopic ultrasound showed a diffuse gastric wall thickening of 15 mm and submucosal tunneling technique biopsy suggested high-grade, invasive, signet ring adenocarcinoma of the stomach. Oncology was consulted to initiate palliative chemotherapy. In retrospect, the patient was questioned regarding gastrointestinal symptoms; he reported gradual early satiety, dysphagia and unintentional weight loss over the course of 4 months.
Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA.
Sehem
S
Ghazala
Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA.
Jawad
J
Bilal
Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA.
Irbaz Bin
IB
Riaz
D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D006801:Humans; D008039:Linitis Plastica / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*