[A case report of perforated early gastric cancer]

An 83-year-old woman was seen at the First Department of Medicine Fukui Medical School because of upper abdominal pain. A simple chest film taken in the upright position revealed free air under the diaphragm. She was referred to the department and underwent a laparotomy with a diagnosis of acute panperitonitis due to a perforated gastric ulcer. At laparotomy, there was a perforation measuring 5 x 5 mm at the anterior gastric body of the lesser curvature, covered with abdominal wall. Billroth I gastrectomy was carried out with no lymph node dissection. The histological examination of the surgical specimen showed early gastric cancer of type IIc invading the submucosal layer around the ulcer in the gastric wall, composed of well differentiated adenocarcinoma. The perforated early gastric cancers often present difficulty in diagnosis pre or intra-operatively. So it is important to examine closely the resected specimen intra-operatively and perform frozen section diagnosis whenever possible. Forty-six cases of perforated early gastric cancer collected from the Japanese literature are also discussed.