A CASE OF QUADRUPLE GASTRIC CANCER WITHIN UPSIDE DOWN STOMACH DUE TO ESOPHAGEAL HIATAL HERNIA

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  • Upside down stomachを呈した食道裂孔ヘルニアに4多発胃癌を合併した1例

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Abstract

Although esophageal hiatal hernia occurs in a relatively high incidence, esophageal hiatal hernia presenting upside down stomach with volvulus in which the entire stomach prolapsed is rare, especially that associated with multiple gastric cancer.<BR>An 85-year-old woman was admitted to the hospital because of dyspnea on effort and palpitation. Chest plain x-ray film and a chest CT scan revealed deviation of the gastrointestinal tract into the left thoracic part. Upper gastrointestinal series visualized so-called upside down stomach in which the entire stomach prolapsed on the left diaphragm. Upper gastrointestinal endoscopy revealed type 2 gastric cancer in the gastric body and two polyps of Yamada′s type III on the antrum. From these findings, esophageal hiatal hernia with gastric cancer was diagnosed and a distal gastrectomy and plication suture of the esophageal hiatus were performed. On the resected material, all antrum lesions were diagnosed as well differentiated adenocarcinoma. Besides these lesions, type IIa well differentiated adenocarcinoma in the anterior wall of the lower part of gastric body which had not been diagnosed preoperatively was confirmed, quadruple gastric cancer being disclosed.<BR>We have difficulty in conducting sufficient preoperative exploration for esophageal hiatal hernia manifesting upside down stomach due to its anatomical characteristics, and hence careful attitude for preoperative diagnosis would be mandatory.

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