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Abstract: The patient, an elderly male, presented with intermittent pain in the upper abdomen with no obvious cause half a year ago, which was obvious before meals and at night, accompanied by abdominal distension without nausea and vomiting, and was examined in our outpatient clinic with gastroscopy suggesting gastric sinus ulcer and biopsy pathology suggesting gastric carcinoma in situ. In order to avoid metastasis, the patient was advised to be admitted to the hospital in time for radical resection and postoperative drug support treatment. Since the cancer was confined to the mucosa and did not metastasize, the patient was discharged with no abdominal pain and bloating after surgery.
Basic information】Male, 60 years old
Disease Type】Carcinoma in situ of the stomach
Hospital】Tianjin Fifth Central Hospital
Date of consultation】July 2021
Treatment plan】Surgery (minimally invasive radical gastric cancer surgery) + drug treatment (metoclopramide hydrochloride injection, bismuth aluminate granules, pantoprazole sodium injection, fat milk injection)
Treatment period】16 days of hospitalization, review after 1 month
Treatment effect】The cancer was limited and cured by surgical resection, and the abdominal pain and distension disappeared.
I. First interview
One day in July 2021, an elderly male patient came to the clinic. The patient reported that he had epigastric pain six months ago, which was intermittent and obvious before meals and at night, accompanied by abdominal distension, without nausea and vomiting. The patient then underwent physical examination: suggesting: flat abdomen, no gastrointestinal type peristaltic waves, soft abdomen, no pressure pain, no rebound pain, bowel sounds 4 times/min, normal bowel sounds, no abnormal manifestations were found. Gastroscopy in outpatient examination showed gastric sinus ulcer; biopsy pathology showed high-grade intraepithelial neoplasia of gastric mucosal glands with local in situ carcinoma, therefore, the preliminary diagnosis was gastric carcinoma in situ. The patient was advised to be admitted to hospital for surgery in time to avoid metastasis of the cancer.
II. Treatment history
The patient was admitted to the hospital for routine preoperative laboratory tests and was found to have no contraindications, and was operated on the following day after fasting from water and emptying food from the stomach for one day before surgery. Minimally invasive laparoscopic radical treatment of gastric cancer was chosen. The morphology of the stomach was normal during surgery, and no signs of tumor invasion were seen on exploration. The postoperative pathology suggested that the cancer foci were confined to the mucosal layer, and the diagnosis of gastric carcinoma in situ was confirmed. After the operation, the patient was given gastrointestinal decompression, pantoprazole sodium injection, fatty milk injection and other drugs on intravenous drip, nutritional support, and kept the drainage open and the wound changed in time. The patient recovered smoothly, and the gastric tube was withdrawn on the 6th postoperative day, and enteral nutrition support was gradually provided through a small intestinal nutrition tube, with a gradual transition from sugar saline to enteral nutrition solution until the resumption of oral feeding. On the 9th postoperative day, the ultrasound of the abdominal cavity clarified that there was no obvious fluid accumulation in the operated area, and the drainage tube was withdrawn. Since it was a carcinoma in situ of the stomach, no follow-up chemotherapy was needed.
III. Treatment effect
The patient with gastric carcinoma in situ had intermittent abdominal pain and abdominal distension after surgery, but the general symptoms were mild. After the resumption of diet, bismuth aluminate granules were given orally to protect the gastrointestinal mucosa and promote the healing of the anastomosis. The laparoscopic surgery was less invasive, with a small skin incision and rapid postoperative recovery. After 16 days of hospitalization, the patient was discharged from the hospital with a repeat abdominal ultrasound showing no effusion in the operated area, gastrointestinal imaging indicating good gastric emptying, and the symptoms of abdominal pain and distension basically disappeared. The patient was instructed to review after 1 month to check the wound recovery.
IV. Precautions
The patient was still in the stage of gastric carcinoma in situ due to timely detection, and was cured through surgical treatment, as the attending doctor was very happy for the patient. However, due to the damage to the stomach caused by the surgery, discomfort symptoms such as abdominal distension and intermittent abdominal pain may occur in the short term, which can be gradually restored to normal through dietary regimen. In addition, the diet should avoid cold, spicy and stimulating foods, and avoid foods such as hawthorn, persimmon and dumplings to avoid aggravating the stomach. Patients can eat less and more meals for 1-3 months after discharge, and gradually transition to three meals a day. Routine outpatient review within 1 year after surgery, if there is no abnormality, the review time can be extended appropriately.
V. Personal insight
Early diagnosis and treatment of gastric cancer is the key to improve patients’ prognosis. If gastric carcinoma in situ is detected and treated in time, the clinical cure rate can reach more than 95%. However, most gastric carcinoma in situ is difficult to be detected, and when it is detected, it may already be in the middle or late stage, which makes the treatment difficult. Therefore, for high-risk groups, screening for gastric cancer is crucial, and it is recommended that the following people should undergo gastroscopy once a year: people with family history of gastric cancer; patients with chronic atrophic gastritis; people with Helicobacter pylori infection; people who consume pickled food and lack of fruit and vegetable diet for a long time. If there is intermittent pain and discomfort in the abdomen, even if the above conditions do not exist, one should be alert to gastric cancer in situ and undergo gastroscopy in a timely manner.