ELECTIVE RADICAL OPERATION AFTER CONSERVATIVE TREATMENT FOR GASTRIC PERFORATION IN A PATIENT WITH EARLY GASTRIC CANCER

Gastric perforation in early gastric cancers is relatively rare and often demands an emergency surgery. We describe a case of early gastric cancer with gastric perforation, in which an elective radical surgery for the gastric cancer was performed following a successful conservative treatment. A 49-year-old woman was seen at the department because of abrupt left hypochondoric pain. A plain abdominal X-ray photograph showed free air under the diaphragm and perforation of the upper gastrointestinal tract was suspected. The patient underwent conservative treatment for the perforation. Fiberscopy revealed an early gastric cancer of type IIc+III at the greater curvature of the fornix 10 days after the conservative treatment for the perforation. Histological diagnosis of biopsy specimens was signet-ring cell carcinoma. She underwent a total gastretomy with D2 lymphadectomy. The invasion of the cancer was within mucosa histopathologically. The final diagnosis was gastric perforation underlying early gastric cancer. No recurrent disease has been detected as of 1 year and 3 months after the operation. Fifty cases of gastric perforation underlying early gastric cancer seen in the Japanease literature are also reviewed.