GASTRIC PERFORATION IN EARLY GASTRIC CANCER-A CASE REPORT-

Gastric perforation in early gastric cancer is a rare condition. We present a case of early gastric cancer with gastric perforation, on whom radical surgery was performed by the two-step procedure. A 59-year-old woman was admitted to our the hospital because of epigastralgia. A plain chest X-ray revealed free air under the diaphragm, and CT showed a hole at the anterior gastric wall, which was highly suggestive of gastric perforation. Therfore an emergency operation was carried out and a part of the omentum was applied to cover a perforation area. There was a perforation measuring 8mm in diameter on the lesser curvature in the upper anterior wall. On the 10th postoperative day, fiberscopy revealed an advanced gastric cancer of type III+IIc at the perforation area. Histological diagnosis of the biopsy specimens was signet-ring cell carcinoma. She underwent total gastrectomy with splenectomy with D2 lymphadectomy 24 days after the previous operation. The invasion of the cancer was within the mucosa histopathologically. The final diagnosis was gastric perforation underlying early gastric cancer. No signs of recurrence have been detected as of 7 months after the operation. In the treatment of gastric perforation, we recommend the two-step approach; the omental coverage is performed, followed by radical surgery if fiberscopy reveals gastric malignancy after the omental coverage.