An 80-year-old male patient with a history of arterial hypertension underwent emergency surgery for gastric perforation at the incisura angularis level of 1 cm in length of probable neoplasic origin.
An open subtotal gastrectomy was performed with D1 lymphadenectomy with Roux-en-Y reconstruction and placement of the jejunal loop 40 cm from the foot of the loop.
The pathological study revealed transmural perforation, active antral atrophic gastritis, as well as extensive intestinal metaplasia with low-grade dysplasia and a focus of high-grade dysplasia-carcinoma in situ (pTisN0).
In the immediate postoperative period she required vasoactive drugs to maintain hemodynamic stability.
She received parenteral nutrition, which on the fourth day was suspected by endoscopic ultrasound and cystoscopy, showing clinical and laboratory improvement.
On the 14th postoperative day she presented severe abdominal pain, desaturation and agitation, CRP 21.40 mg/dl, and neutrophilia without leukocytosis.
An urgent CT scan showed a small intestine perforation in the right flank, a large peritoneal collection of 18 x 7.4 x 8 cm at the subheptic level with ectopic gas bubbles inside.
An urgent laparotomy was performed which showed collection with white contents anterior to a thickened point, dense solid, compatible with NE, and adjacent to this, a small intestine perforation of about 3 cm in diameter caused by an NE.
Resection of both and manual anastomosis were performed after exhaustive lavage of the cavity.
The anatomopathological study of the perforations revealed hemorrhagic necrosis with signs suggestive of ischemia.
In the subserosa and peritoneum abundant inflammatory cellularity of mixed type and giant cells to foreign body in relation to material from the intestine was observed.
The patient died a week due to respiratory failure associated with trilobar pneumonia of fungal origin.
