Emre Ergul1, Erdal Ozgur Gozetlik. 1. General Surgery Department, Ankara Ataturk Teaching and Research Hospital, Askaabat Cad. Eser Sitesi B Blok 3.giris Daire:11, 06480, Bahcelievler, Ankara, Turkey.
Abstract
BACKGROUND: The spontaneous perforation of gastric cancer is a rare fatal complication, occurring in 1% of patients with gastric cancer, and it has a wide hospital mortality range (0-82%). In addition, it has been reported that about 10-16% of all gastric perforations are caused by gastric carcinoma. The aim of this study is to evaluate the gastric perforations and improve an alternative pathway for the management of this disorder when a pathologist is not available. MATERIAL AND METHODS: We reviewed the medical records of 513 patients who had undergone surgical treatment for gastric perforation due to gastric ulcus or gastric carcinoma in two medical centers. Sixty-seven (13.06%) patients were treated for perforated gastric carcinoma. Perforations due to trauma and iatrogenic causes were excluded. The clinicopathologic features of all patients were analyzed on the basis of their medical records. RESULTS: According to the results of our analysis, we can suggest that if a patient with gastric perforation has an age more than 60 years, an ulcus diameter (with edema) more than 6 cm, a perforation diameter more than 0.5 cm, a symptom duration of more than 20 h, and a white blood cell count less than 15.10(3)/microL, he might have a gastric carcinoma. This system has a specificity of 98.7%, a sensitivity of 53.7%, a negative predicted value of 93.4%, and positive predicted value of 85.7%. CONCLUSION: The diagnosis of malignancy is often made only on postoperative or operative frozen pathologic examination. We suggest a new pathway for the gastric perforations, if a pathologist is not available during the operation.
BACKGROUND: The spontaneous perforation of gastric cancer is a rare fatal complication, occurring in 1% of patients with gastric cancer, and it has a wide hospital mortality range (0-82%). In addition, it has been reported that about 10-16% of all gastric perforations are caused by gastric carcinoma. The aim of this study is to evaluate the gastric perforations and improve an alternative pathway for the management of this disorder when a pathologist is not available. MATERIAL AND METHODS: We reviewed the medical records of 513 patients who had undergone surgical treatment for gastric perforation due to gastric ulcus or gastric carcinoma in two medical centers. Sixty-seven (13.06%) patients were treated for perforated gastric carcinoma. Perforations due to trauma and iatrogenic causes were excluded. The clinicopathologic features of all patients were analyzed on the basis of their medical records. RESULTS: According to the results of our analysis, we can suggest that if a patient with gastric perforation has an age more than 60 years, an ulcus diameter (with edema) more than 6 cm, a perforation diameter more than 0.5 cm, a symptom duration of more than 20 h, and a white blood cell count less than 15.10(3)/microL, he might have a gastric carcinoma. This system has a specificity of 98.7%, a sensitivity of 53.7%, a negative predicted value of 93.4%, and positive predicted value of 85.7%. CONCLUSION: The diagnosis of malignancy is often made only on postoperative or operative frozen pathologic examination. We suggest a new pathway for the gastric perforations, if a pathologist is not available during the operation.
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Authors: Antonio Tarasconi; Federico Coccolini; Walter L Biffl; Matteo Tomasoni; Luca Ansaloni; Edoardo Picetti; Sarah Molfino; Vishal Shelat; Stefania Cimbanassi; Dieter G Weber; Fikri M Abu-Zidan; Fabio C Campanile; Salomone Di Saverio; Gian Luca Baiocchi; Claudio Casella; Michael D Kelly; Andrew W Kirkpatrick; Ari Leppaniemi; Ernest E Moore; Andrew Peitzman; Gustavo Pereira Fraga; Marco Ceresoli; Ronald V Maier; Imtaz Wani; Vittoria Pattonieri; Gennaro Perrone; George Velmahos; Michael Sugrue; Massimo Sartelli; Yoram Kluger; Fausto Catena Journal: World J Emerg Surg Date: 2020-01-07 Impact factor: 5.469