Krukenberg tumor after gastric bypass for morbid obesity: Bariatric surgery and gastric cancer

Abstract

Gastric bypass is one of the most frequently performed surgical procedures in bariatric surgery. A neoplasm within the gastric pouch is a somewhat infrequent complication but with important survival consequences. We present the case of a 51-year-old woman who developed an adenocarcinoma in the bypassed stomach three years after bariatric surgery; the tumour was incidentally discovered after gynaecological surgery for uterine myomas. Various diagnostic modalities for the excluded stomach were analysed.Key words: Bariatric surgery. Gastric cancer. Morbid obesity. Krukenberg tumour. INTRODUCTIONMedical treatment for morbid obesity can be effective in the short and medium term, but usually ends in failure, making the surgical option necessary. Gastric bypass is one of the most frequently performed surgical procedures in bariatric surgery; a neoplasm is a somewhat infrequent complication. A Krukenberg tumour is a metastatic signet-ring adenocarcinoma of the ovary with variants of gastro-intestinal primary, detected either synchronously or metachronously (1). We present a case of a Krukenberg tumour due to an adenocarcinoma in the bypassed stomach after bariatric surgery. CASE REPORTA 51-year-old woman suffering from Graves-Basedow disease, depressive disorder, right bundle branch, tubal ligation, cholecystectomy and obesity, had undergone a gastric bypass for morbid obesity three years ago; her initial body mass index (BMI) was 47.65 kg/m 2 (122 kg). She was taken to the Emergency Department due to a syncopal, dysphagia, vomiting and constitutional syndrome, with 55.5 kg weight (BMI 21.68 kg/m 2 ). It was necessary to carry out a hemoderivative transfusion due to 4.2 g hemoglobin/dL (hematocrit 13.3 %). Computed tomography (CT) and gastrointestinal transit were carried out during her hospital stay, indicating an ulcerated stenosis at the gastroyeyunal anastomosis, which was treated by endoscopic dilatation. Patient was discharged, and later, a hysterectomy with bilateral salpingo-oophorectomy was performed due to uterine myomas; histopathology revealed a metastatic adenocarcinoma in the left fallopian tube and a Krukenberg tumour in the left ovary. Due to the histopathological findings, a CT scan was performed and revealed a stenosis in the gastric bypass due to a mass in the bypassed stomach (Fig. 1). Following eight neoadjuvant cycles of chemotherapy (epirubicin, cisplatin and flurouracil, every 21 days), a total gastrectomy was done, resulting in the removal of gastric adenocarcinoma (Lauren type) with infiltration of all the gastric wall and the intestinal segment, and with metastasis in 15 lymphatic nodes. The classification of this tumour was pT4N2Mx. There was no evidence of recurrence six months after surgery and adjuvant treatment. Vol. 105. N.° 5, pp. 296-298, 2013 Received: 23-10-201223-10- Accepted: 27-11-2012 Correspondence: Pablo Menéndez Sánchez. Department of General and Digestive Surgery. Hospital Gutiérrez Ortega. Avenida de los Estudiantes, s/n. 13300 Valdepeñas, Ciudad Real. Spain e-...

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“…After other bariatric operations additional 33 carcinomas of the upper gastrointestinal tract are described. The majority of the tumors, n = 19, was located in the distal esophagus, at the cardia or within the proximal gastric pouch (Table 2) (4,5,6,7,8,9,10,11).…”

Gastric Cancer After Roux-en-Y Gastric Bypass: A Case Report and a Systematic Review

“…In English literature there are, up to date, about 17 case reports [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] (Table 1).…”