Metastatic Gastric Remnant Cancer Occuring Six Years after Partial Gastrectomy for Gastric Ulcer

Abstract

To describe an early development of metastatic gastric cancer following a partial gastrectomy for a benign condition A case report Gastric stump cancer is known to occur following partial gastrectomy for benign diseases. However, the risk is believed to increase four to fivefold, 20 to 25 years after gastrectomy. We report a 41-year-old man with history of tobacco and alcohol abuse who presented with abdominal pain and constipation. He underwent partial gastrectomy six years previously for gastric ulcer. There was no evidence of malignancy in the surgical specimen and sampled lymph nodes at that time. He was admitted for acute pancreatitis. CT abdomen revealed multiple liver lesions, and biopsy revealed poorly differentiated metastatic adenocarcinoma. EGD revealed mild esophagitis, and duodenal erosion but colonoscopy was normal. CEA and B-HCG were elevated, but AFP was normal. The patient's condition deteriorated and he died before palliative chemotherapy could be started for cancer of unknown primary. At autopsy, there was no gross stomach lesion, but the histopathology at the anastomotic site revealed adenocarcinoma with signet ring features. We reviewed the literature to highlight the need for identification of patients at risk of developing gastric stump cancer especially as it is now being described even in patients who underwent gastric bypass surgery for obesity, a population that continues to increase. More studies are needed to better define any predisposition to cancer following gastric surgery