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A Case of Perforated Gastric Cancer Arising from an Upside-Down Stomach Thorough Para-Esophageal Hiatal Hernia

Mahtab Vasigh, Mohammad Reza Karoobi, Hossein Zabihi Mahmoudabadi, Hossein Zabihi, Ehsan Rahim Pour, Pedjman Farshidmehr and Reza Hajebi

Herein we report on a case of complicated adenocarcinoma arising from an upside-down stomach in an elderly patient. An 84-year-old woman was brought to the emergency department of our hospital with abdominal pain, nausea and vomiting. AA Chest CT and an abdominopelvic CT revealed that the entire stomach had migrated into the posterior mediastinum and there was some air and fluid in the peritoneal cavity. The patient underwent a laparotomy. The upside-down stomach herniated thorough hiatal hiatus was reduced. There was a tumor at the ant rum of the stomach which had been perforated. A subtotal gastrostomy and regional lymph node dissection with Roth and I. reconstruction and Braun procedure was done. The hiatal defect was closed by primary suturing of the right and left crura at the anterior space of the esophagus. The patient became septic within the post-op period and she expired a week after the surgery. To the best of our knowledge, this is the seventeenth case reported of adenocarcinomas in an upside-down stomach and the only case which was diagnosed due to a complication.