Surgical Outcome of a Perforated Gastric Carcinoma With Signet Features

AFFILIATIONS:
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

CITATION:
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.

DISCLOSURES:
The authors report no relevant financial relationships.

ACKNOWLEDGEMENTS
None.

CORRESPONDENCE:
Ibrahim Farah, MD, 503 Ponthieu Circle, Ottawa, Ontario, K1W 0N5, Canada (Ibrahim.farah11@gmail.com)

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. 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.