Peer Reviewed


Surgical Outcome of a Perforated Gastric Carcinoma With Signet Features

Ibrahim Farah, MD1 • Marwan Zaarab, MD1 • Juaquito M. Jorge, MD2• Frederick M. Tiesenga, MD3

1Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
2The Department Surgery, West Surburban Medical Center, Oak Park, IL

3Chairman, The Department of Surgery, West Suburban Medical Center, Oak Park, IL

Farah I, Zaarab M, Jorge JM, Tiesenga FM. Surgical outcome of a perforated gastric carcinoma with signet features. Consultant. 203;63(4):e9. doi:10.25270/con.2023.02.000001

Received August 19, 2022. Accepted November 23, 2022. Published online January 30, 2023.

The authors report no relevant financial relationships.


Ibrahim Farah, MD, 503 Ponthieu Circle, Ottawa, Ontario, K1W 0N5, Canada (

Introduction. A 51-year-old Black man presented to the emergency department (ED) with a 1-month history of abdominal pain, nausea, and non-bloody/non-bilious vomiting, which was associated with difficulty swallowing, decreased oral intake, and a weight loss of 40 pounds in the interim.

History. His past medical history was unremarkable, except daily inhalational heroin use prior to admission and a 20 pack-years smoking history. The patient underwent a splenectomy 23 years prior to presentation.

Diagnostic testing. Physical examination was remarkable for generalized abdominal tenderness and a fever of 99.8°F. Initial investigations included a complete blood count (CBC), which was notable for anemia with a hemoglobin of 6.8 g/dL. He was transfused two units of packed red blood cells. A computed tomography (CT) scan of the abdomen and pelvis without contrast showed an extraluminal air-fluid collection along the proximal lesser curvature (Figures 1 & 2).

Figures 1 & 2. Non-contrast CT of abdomen & pelvis.

Next, we ordered a CT with contrast, which showed a rim-enhancing collection extending from the gastric body. This was suspicious for a large subacute perforated gastric ulcer and a contained gastric abscess.


Figure 3 

Figure 3. CT of abdomen & pelvis with contrast.

A esophagogastroduodenoscopy (EGD) was performed subsequently, which showed candida esophagitis and two large gastric ulcers arising from the lesser curvature and the antrum of the stomach (Figures 4 & 5).  Additionally, a gastric biopsy from the ulcers showed a poorly differentiated adenocarcinoma with signet features and HER2/neu negative.