DISSEMINATED METASTASIS OF STOMACH CANCER AND PREFORATION OF THE TRANSVERSE COLON

Abstract

The patient was a 54-years-old housewife, whose chief complaint was abdominal pain. The preoperative diagnosis was acute abdomen with perforation of the stomach or bowel. The operative findings were disseminated carcinomatous metastasis in the abdominal cavity from an unknown primary lesion and perforation of transverese colon. The patients life saved, and fecal peritonitis was cured by resection of the transverse colon recoginizing the existence of the perforation and irrigation of the abdominal cavity. The primary lesion of this cancer could not be diagnosed by various examinations including fluoroscopy and endoscopic examination in the pre- and postoperative period. The primary lesion of the cancer was found at autpsy to be a Borrmann 4 typed stomach cancer. We classified this perforation of the transverese colon as diastatic perforation although there was no obstruction at the anal side of the bowel. The form of perforation in this patient was somewhat similar to idiopathic perforation of colon with a long longtudinal tear at the antimesenteric border. Consideration of the perforative mechanism in this patient suggests some difficulty of the classification of idiopathic perforation, spontaneous perforation, stercoracious perforation, or diastatic perforation. Further, the pathologic factors of these perforatins and their different mechanisms need to be considered.