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Gastric perforation repaired by hepatic round ligament: Case report and literature review
Ribal Aby Hadeer1, Angela Assaad2, Hadi Farhat1
1Department of General Surgery, University of Balamand, Beirut, Lebanon.
Rationale:
Gastric perforation is a rare but life-threatening complication of gastric cancer, often presenting with acute peritonitis and requiring emergent surgical repair. The conventional treatment relies on an omental patch (Graham's technique); however, this approach is not always feasible, particularly in patients with advanced disease or omental involvement.
Patient Concerns:
We report the case of a 44-year-old male with advanced gastric adenocarcinoma complicated by peritoneal carcinomatosis who presented with acute abdomen following stent insertion.
Diagnosis:
Imaging confirmed gastric perforation and generalized peritonitis.
Interventions:
During emergent laparoscopic exploration, the omentum was unsuitable due to carcinomatous infiltration. Instead, the hepatic round ligament was mobilized and used as a patch to seal the perforation, achieving effective closure. The patient initially recovered well postoperatively; however, he later deteriorated due to progression of his underlying malignancy and died on postoperative day 16.
Outcomes And Lessons:
This case highlights the hepatic round ligament as a viable alternative to the omentum in repairing gastric perforations, particularly in malignant or hostile abdominal environments. Wider application of this technique warrants further study to establish its safety and long-term outcomes.
