A 64-year-old male patient was diagnosed in May 2014 with gastric adenocarcinoma affecting the gastrointestinal junction (after stage IV cytology of ascitic fluid that was positive for malignancy).
The first-line treatment is EOX: epirubicin 91.5 mg (50 mg/m2) + oxaliplatin 237.9 mg (130 mg/m2) every 21 days intravenous + capecitabine (650/12).
After the administration of four cycles of chemotherapy, clinical improvement was observed, which, after radiological confirmation, led to surgery.
A total gastrectomy was performed, with excision of a hepatic cyst and cholecystectomy.
One month later, he required a second intervention due to biliary leakage and one month later he required placement of a transparietal drainage per collection in the right hypochondrium.
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In February 2015 she started ramucirumab and a month received six subcutaneous doses of 300 mcg filgrastim (two consecutive weekly doses for three weeks).
After five months of treatment, the patient was admitted to the hospital for fever of unknown origin, probably due to tumor, so she received oral neno (500 mg/12h) and dexamethasone (4 mg/12h intravenously) for 2 days.
Two days after discharge she received the 12th cycle of ramucirumab with paclitaxel and again came to the emergency department complaining of sudden abdominal pain and rectal bleeding after the administration of the cycle.
Abdominal computed tomography (CAT) revealed a splenic rupture and perianastomotic jejunal fistula.
She underwent emergency cholecystectomy and fistula drainage.
During hospitalization, the patient evolves torpidly due to suffering several intra-abdominal abscesses and bilateral pleural effusion, requiring palliative care at home after discharge one and a half months after admission.
The patient suffers two repeated admissions for bilateral pulmonary thromboembolism and respiratory infection that is treated with levofloxacin, 500 mg a day, and poorly controlled abdominal pain.
After performing a new abdominal CT and elevated tumor marker (CA 19.9) is diagnosed with intestinal obstruction secondary to peritoneal carcinomatosis, being treated in the Palliative Care Unit.
Given the deterioration of the patient, the patient was referred to the Palliative Care Hospital, where he died in the following months.
