ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ CHẨN ĐOÁN UNG THƯ DẠ DÀY THỦNG

Abstract

Aim of study: 1. Evaluation of the clinical and paraclinical feature of gastric cancer perforation. 2. Diagnosis of gastric cancer perforation. Patients and method: Retrospective study. Time: 2022-2/2025. Results: + There were 35 patients, male 28, female 7, mean age 65,2. + Medical history: gastroduodenal ulcer in 4 patients; perforation of gastroduodenal ulcer in 4 patients, gastro-jejunostomy in 2; gastric cancer perforation in 1 (simple closure), rectal cancer in 1; others in1 patient. + Clinical feature: Violent anh  diffuse abdominal pain in  26/35(74,3%); pain with fever in  2 patients; pain with digestive bleeding (hematemesis or melena in 5/35 patients. + Abdominal Xray revealed free air under diaphragm  24/35 (68,6%); CT Scan showed free air and intraabdominal liquid in 22/35 patients; abscesse adjacent to  greater curvature in 1 patient;  Free air in lesser sac in 1 patient. + Gastroduodenalscopy revealed gastric cancer prior perforation in 14/35 (40,0%). + Emergency opreration in 26/35 patients (74,3%); Elective operation in 9/35 patients (25,7%); + Operation time (from onset abdominal pain to operation) ≤24h in 22/35 patients (62,86%); >24h in 4/35 patients (37,14%).in 9 patient that perforation eroded to adjacent  organs. + The location of perforation: Middle part of stomach 3/35 (8,6%); upper part of stomach 2/35 (5,7%, proximal), 30/35 lower part of stomach  (85,7%, distal). + Average diameter of perforation: 2,386 cm; The average diameter of tumor: 6,45 cm. Conclusion: n=35, average age 65,2 Y; male 80,0%, female 20,0%; sex ratio male/female 4/1; 1. Clinical and paraclinical presentation. Medical history: Gastroduodenal ulcer or suture of ulcer perforation 8/35(22,9%); 3/35 (8,6%) suture of gastric cancer perforation or gastrojejunostomy due to peritoneal metastasis, 1/33 had rectal cancer resection; - Clinical and paraclinical feature: diffuse and violent abdominal pain in 26/35 (74,3%), Abdominal pain with fever in 2/35 (5,7%). Tenderness and guarding in  68,6%; Digestive bleedinh in 4/35 (11,4%); White  blood cell elevated more than > 10.000 G/L in 25/35 (71,4%).  Abdominal Xray showed free air under diaphragm in 68,6%.CT scan showed air and intraabdominal liquid in 62,85%, air in lesser sac in one, abscess  adjacent to great curvature in one. 2. Diagnosis: Free perforation into abdominal cavity in 68,6%, perforation eroded into adjacent organs in 25,7%( 9/35); perforation into lesser sac in one and abscess formation at greater curvature in one. Urgent operation ≤ 24 h (from the initial onset) in 22/35 (62,86%); >24h in 4/35 (11,4%). Elective surgery (Eroded perforation) in 9/35 (25,74%). The location of perforation: middle part of stomach 3/35 (8,6%); upper part of stomach 2/35 (5,7%)(proximal), 30/35 lower part of stomach (distal) (85,7%).