Hospital: Hospital Virgen de la Salud.
Ciudad:
Nº:
Aut@r o Autores: I. Cifuentes García, M.M. Merideno García, C. De La Cruz Rodríguez, A. Palomares Morales, M.J. Lucena González, A. Pérez Martínez.,
Presentación:
A 54-year-old male patient was admitted to the Hospital due to upper gastrointestinal bleeding. At endoscopy, a forrest IIC and III ulcer of indeterminate appearance was found. After endoscopy, the patient presented an episode of acute abdominal pain with clinical worsening and peritoneal irritation. Emergent abdominal CT was performed, finding a pronounced gastric wall thickening, with stenosis and dilatation. At the level of the stenosis, there was a gastric wall discontinuity, with small free air bubbles adjacent to it, compatible with perforation. It associated abundant free intraperitoneal fluid. In addition, there was an increased density and stranding of the fat of the greater omentum, suggesting peritoneal carcinomatosis. The patient underwent urgent surgical intervention which proved the perforated gastric neoplasm and the unresectability of the lesion. After surgery, the patient suffered rebleeding which resulted in death.The anatomopathological result was carcinoma with “signet ring” cells.
Discusión:
Gastric perforation is the most common complication in peptic ulcer disease. However, it can also appear with gastric cancer, particularly in ulcerate masses, such as adenocarcinoma, linfoma and GISTs. Because of its higher prevalence, gastric adenocarcinoma is the most common malignant lesion which tent to produce perforation. It is a rare complication with fatal outcome, with a reported incidence of 0.4– 6.0%, and it often appears in patients who are 65 years old or higher in an advanced stage of the disease. In lower stages of the disease, a focal ulcerated mass could be perforated if the ulceration is deep. Diagnosis of gastric perforation can be made by CT findings, such as gastric wall discontinuity, extraluminal air and fluid, located mainly nearly perforation, and perigastric fat stranding. Also, the underlying malignancy can be predicted by CT findings. Marked gastric wall thickening, perigastric softtissue extension, omental cake formation and lymph-adenopathy enlargement suggest neoplasm.
Conclusión:
Gastric perforation is the most common complication in peptic ulcer disease. However, it can also appear with gastric cancer, particularly in ulcerate masses, such as adenocarcinoma, linfoma and GISTs. Because of its higher prevalence, gastric adenocarcinoma is the most common malignant lesion which tent to produce perforation. It is a rare complication with fatal outcome, with a reported incidence of 0.4– 6.0%, and it often appears in patients who are 65 years old or higher in an advanced stage of the disease. In lower stages of the disease, a focal ulcerated mass could be perforated if the ulceration is deep. Diagnosis of gastric perforation can be made by CT findings, such as gastric wall discontinuity, extraluminal air and fluid, located mainly nearly perforation, and perigastric fat stranding. Also, the underlying malignancy can be predicted by CT findings. Marked gastric wall thickening, perigastric softtissue extension, omental cake formation and lymph-adenopathy enlargement suggest neoplasm.
Bibliografía:
– Guniganti P, H. Bradenham C, Rapis C, O. Menias C, M. Mellnick V. “CT of Gastric Emergencies”. RadioGraphics 2015, 35: 1909-1921. – Kim S W, Kim H C, Yang M. “Perforated tumours in the gastrointestinal tract: CT findings and clinical implications”. Th