Sharique Nazir, MD, Sean Rim, MD, Salvatore Docimo Jr, DO, MS, Zheng Dong, Galina Glinik, MD, FACS
Lutheran medical center
Introduction: Gastric carcinoma is the second leading cause of cancer related death worldwide with 21,860 new cases and 11,550 deaths in the United States in 2005. The median age for gastric carcinoma is 70 years in males and 74 years in females. Previous literature reports a more aggressive course in patients diagnosed before the age of 40. We report a rare case of gastric adenocarcinoma in a 17-year-old Chinese male.
Case: A 17- Introduction: Gastric carcinoma is the second leading cause of cancer related death worldwide with 21,860 new cases and 11,550 deaths in the United States in 2005. year-old Chinese male presented in the emergency room with a chief complaint of stomach pain. The patient stated the pain began in the upper abdomen and progressively worsened. He described the pain as a persistent, non-radiating, 10 out of10 with no provoking or alleviating factors. The patient also described three episodes of vomiting and normal bowel moments. He denied any significant medical, surgical, or family history and no known allergies. He denied the use of alcohol but smoked cigarettes. Vitals were within normal limits. The abdomen was soft with diffuse tenderness to palpation with more tender to palpation.
The WBC count increased from 12,000 µL to 21,000 µL in 12 hours and a CAT scan demonstrated moderate free fluid in the pelvis. A diagnostic laparoscopy was performed which demonstrated approximately 400cc of murky yellow fluid in the pelvis. Further examination demonstrated a fibrinous exudate at the greater curvature of the stomach and the liver with concern for a possible gastric perforation. Exploratory laparotomy was performed and a small 6 mm perforation was identified with extensive fibrinous exudate at the greater curvature of the stomach as well as inflammatory changes of Further examination demonstrated a fibrinous exudate at the greater curvature of the stomach and the liver with concern for a possible gastric perforation. the stomach. The surrounding areas of the ulcer were found to be hard and friable. A wedge resection of the greater curvature of the stomach was performed. Pathologic demonstrated a grade 3 (poorly differentiated) invasive gastric adenocarcinoma invading serosa. Pathologic staging was T4a, N0, MX. Patient subsequently underwent adjuvant chemotherapy, total gastrectomy, and Roux-en-Y anastomosis and was doing well at time of discharge. Radioisotope bone scan showed no bony metastasis.
Discussion: In the US, gastric cancer roughly represents 2% of all new cancer cases yearly but it is the second most common cause of cancer death worldwide after lung cancer. Metastasis is common upon presentation with a six-month survival rate of 15% diagnosised at later stages. Diagnosis of gastric cancer before the age of 30 is extremely rare. Symptoms upon presentation are often nonspecific and include belching, indigestion, and early satiety. Our patient presented with diffuse abdominal pain secondary to gastric perforation. Physician’s differential diagnosis should include gastric carcinoma for patients endemic to areas with high incidence of the pathology. Prompt identification and treatment is essential to ensure a favorable.
Session: Poster Presentation
Program Number: P221