A CASE OF EARLY GASTRIC CANCER PROLAPSED INTO THE DUODENAL BULB IN A 90-YEAR-OLD WOMAN

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  • 十二指腸球部に脱出した超高齢者早期胃癌の１例

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Abstract

A 90-year-old woman was referred and admitted to our hospital for pneumonia. After admission, anorexia and vomiting occurred, and an endoscopy of the upper digestive tract using the bulb inversion method revealed a granular nodular tumor measuring 4cm, which prolapsed from the pyloric antrum into the duodenal bulb. It was impossible to reduce the tumor from the duodenal bulb into the stomach. Contrast-enhanced radiography of the upper digestive tract showed a lobular tumor measuring 4cm and prolapsing into the duodenal bulb. The gastric mucosa was extended from the pyloric antrum to the duodenal bulb. Preoperative respiration training and total parenteral nutrition (TPN) management resulted in a stable general condition. Therefore, distal gastrectomy (D2) and Roux-en-Y anastomosis were performed. Macroscopically, a semipedunculated tumor measuring 7.5×4.5×4.0cm was observed on the posterior wall of the pyloric antrum. The histopathological findings suggested tubl, m, ly0, v0, INFα, n0, and stage I A. The postoperative course was uneventful, and the patient was discharged 10 days after the surgery. In Japan, only 5 elderly patients (over 85 years) with gastric cancer prolapsing into the duodenal bulb, including our patient, have been reported.

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