Gastric Cancer Revealed by a Perforated Ulcer: A Case Report and Review

Introduction: Gastric cancer is not typically a surgical emergency. However, it can evolve into urgent complications such as a perforation. We report a case of a perforated gastric ulcer that turned out to be a cancer. Observation: A 52-year-old man was admitted to the emergency department of Hubert-Koutoukou-Maga National University Medical Center in Cotonou for generalized abdominal pain. He was diagnosed with acute generalized peritonitis with perforated gastric ulcer, establishing a surgical indication. An antral perforation was found and a simple closure was performed. Anatomopathological examination of the surgical piece revealed a gastric adenocarcinoma within the granulation tissue. Following the impact assessment, he underwent a second surgery where a distal gastrectomy was performed with D2 lymphadenectomy followed by gastrojejunostomy. He developed an anastomotic gastrointestinal fistula during the postoperative period but was successfully medically treated. The patient received adjuvant chemotherapy with Epirubicin, Cisplatin and 5-Fluorouracil. The patient is still alive, 3 years after the gastrectomy. Conclusion: When faced with a perforated gastric ulcer, one must also consider a neoplastic cause. The emergency surgical treatment depends on the general condition of the patient and the pre-existing co-morbidities, the choice being made between a one-stage versus two-stage gastrectomy.