2761 Adenocarcinoma Presented as Massive Gastric Distention

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INTRODUCTION: Chronic gastric distention is a rare condition that can occur due to an underlying obstruction or dysmotility. Gastric outlet obstruction can be secondary to luminal, mural or extrinsic compression. Gastric adenocarcinoma can rarely manifest as massive gastric distention due to partially obstructing mass or peptic stricture. Herein we presented a case of chronic massive gastric distention due to pyloric adenocarcinoma. CASE DESCRIPTION/METHODS: A 60 y/o male patient with PMHx of hepatitis C, hypertension and polysubstance abuse, presented to the ER complaining of diffuse abdominal pain, intermittent nausea and vomiting, early satiety and 25lb weight loss over the last 8 months. He seeked medical attention due to worsening symptoms. He described normal bowel movements. He denied any fever, hematemesis, hematochezia, or melena. On exam: Pulse 84 bpm, temp 36.6 C°, BP 144/68 and RR 18 bpm. His BMI was 22. He was alert and oriented with mild distress due to abdominal pain. His abdomen was mildly distended with tympanic percussion and normal active bowel sounds. His lab results revealed WBC 4.7k/mcl, Hgb 12.9 mg/dl and normal basic metabolic panel. CT scan of the abdominal revealed markedly distended stomach with ingested debris extending to the pelvis with a mass effect on surrounding abdominal structures [Figure 1]. He was treated conservatively with NG tube placement and 3L of fluid removed. EGD revealed ulcerated partially obstructive pyloric malignant looking lesion with large amount of retained bezoar/food [Figure 2]. Histopathology confirmed the diagnosis of gastric adenocarcinoma with mucinous differentiation and signet ring cells. The patient underwent total gastrectomy with Roux-en-Y reconstruction with plan for outpatient follow up. DISCUSSION: Gastric distention was initially described by Duplay in 1833. Benign underlying etiology account for vast majority of cases, with one study calculated up to 90% of cases were seen in the setting of peptic ulcer disease alone. Amongst the malignant causes, gastric adenocarcinoma is important to consider, despite its rarity in the western countries. Gastric adenocarcinoma often presents with nonspecific symptoms and diagnosed at an advanced incurable stage. Serious complications of massive gastric distention include dehydration, ischemia and perforation that might lead to sepsis, multi-organ failure and death. Treating physician should keep high index of suspicion with prompt decompression and surgical intervention to prevent these dreadful sequelae.