Korean J Gastroenterol.  2024 Feb;83(2):65-68. 10.4166/kjg.2023.147.

A Giant Gastric Perforation Occurring in the Normal Mucosa during Endoscopy in a Patient with Advanced Gastric Cancer

• Lee CM
• Kim SJ

• KMID: 2553437
• DOI: http://doi.org/10.4166/kjg.2023.147

Abstract

The incidence of giant gastric perforation occurring during upper gastrointestinal endoscopy is exceedingly rare. Gastric perforation can arise from excessive air insufflation and is more prevalent in elderly patients with atrophic gastritis. Although giant gastric mucosal lacerations during diagnostic endoscopy have occasionally been reported, there are few reports of giant gastric perforation. The authors experienced a giant gastric perforation occurring in the normal mucosa during endoscopy in an 81-year-old woman with advanced gastric cancer. The patient had reduced gastric extensibility due to the advanced gastric cancer surrounding the entire lower part of her stomach. During continuous air insufflation, only the upper part of the stomach became overdistended, resulting in mucosal rupture and perforation. In addition, old age and the presence of atrophic gastritis contributed to the increased risk of mucosal rupture. The patient was treated successfully with endoscopic clips. This paper reports this case with a review of the relevant literature.

Keyword

Stomach rupture; Endoscopy; Clips

Figure

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  Fig. 1 Coronal view of a computed tomography scan shows marked wall thickening of the stomach lower body and antrum.

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  Fig. 2 Endoscopic findings. A giant gastric perforation extending from the cardia to the midbody lesser curvature of the stomach was observed. Fatty tissue in the abdominal cavity and oozing bleeding were noted at the perforation site. The length of the tear was approximately 6 cm, and the perforation measured approximately 3 cm.

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  Fig. 3 Endoscopic findings. The gastroesophageal junction was intact.

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  Fig. 4 Plain abdominal X-ray shows a large amount of free air in the abdominal cavity.

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  Fig. 5 Endoscopic finding. The perforated site was treated using eight endoscopic clips.

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