Ruptured Hemorrhagic Liver Metastasis in a Gastric Cancer Patient – Case Report

Abstract

Background

Gastric cancer is a type of tumor that develops in the lining of the stomach. Most common histological type is adenocarcinoma of varying degree of differentiation. Other known types are gastric lymphomas or mesenchymal tumors. Treatment of gastric cancer depends on the stage, but surgery can be the only curative option. Early gastric cancer patients benefit from mini-invasive techniques such as endoscopic mucosal resection. However, more advanced stages require major surgical resection. Gastric cancer treatment is complemented by chemotherapy, radiotherapy and targeted immunotherapy. There is a common consensus that most cases of advanced gastric cancer (stage IV) with liver metastases do not benefit from major surgery, but should continue other treatment options. In emergency cases surgical intervention may be unavoidable.

Case presentation

Our patient is a 49 years old male diagnosed 4 months prior to the current events with gastric adenocarcinoma, with a liver metastasis of 4×5cm in the VI-th segment. He was ongoing a chemotherapy course. During the 3rd cycle of chemotherapy, he suffers from major hemorrhage manifested with melena and hematemesis. He was treated at the nearest regional hospital. The surgeons concluded that the patient should undergo emergent surgery to stop the hemorrhage. A subtotal gastrectomy was performed. Just about the moment for the abdominal closure, the metastasis of the VI-th segment ruptures, with a following abundant intraperitoneal hemorrhage. Under the conditions of unattainable hemostasis, the surgeons bandage the lesion and the right lobe with gauzes and prepare the immediate transfer of the patient in our clinic where he underwent a second intervention for the resection of the segment VI of the liver where metastasis was ruptured. On the 10^th postoperative day, the patient was discharged in an improved condition.

Discussion

Gastric cancer with hepatic metastases is an advanced stage and thus has a poor prognosis. In these cases, the first-line treatment is systemic chemotherapy. Surgery is most often performed only in severe gastro-intestinal symptoms such as hematemesis and melena that do not respond to conservative measures, or to overcome obstruction.

Conclusion

The majority of retrospective studies does not support the surgical resection surgery in advanced cases, as it is detrimental to the overall prognosis. On the other hand, the benefits hepatic resection for colorectal cancer metastases have been clearly established. Conversion therapy for stage IV gastric cancer is a topic of ongoing investigation and the frontier of oncologists and general surgeons.

Keywords: General Surgery, Gastric Cancer, Liver Metastasis, Liver Resection, Ruptured Metastasis.

DOI: 10.7176/JEP/14-27-05

Publication date:September 30^th 2023