ĐIỀU TRỊ PHẪU THUẬT XUẤT HUYẾT TIÊU HÓA DO UNG THƯ DẠ DÀY - DẠ DÀY ĐÔI HÌNH ỐNG

Abstract

Study aim: 1. Evaluation the clinic and paraclinic feature of bleeding gastric cancer  arising in gastric duplcation cyst patient. 2. The result of surgical management  and review of  literature. - Patient and method: + Retrospective study: Case report. Result: ++ Female 51 years old, admission on 26/9/2022 for hematemese  with massive volume and melena. ++ Examination:  Anorexia,malaise,abdominal pain (epigastric), epigastric mass. ++ Upon investigation: A gastroscopy revealed a ulceration  3 cm in diameter  that perforated to  the greater curvature of stomach (there was fistula tract intra  gastric lumen and cyst ). ++ CT scanner: The cyst mesured  73-88 mm in diameter at the greater curvature of stomach,thicked wall communicated with the gastric lumen (filling defect) containing air and fluid intra lumen of stomach. ++ Laboratory exammination: Globule: 3,27 G/L,Hemoglobule (Hb): 9,2 g/lL hematocrit  0,27 L/L,leucocyte: 13,4 G/L. Glumerulemie:752 G/L. Prothrombin 86%, APTT 27,6 s, IRN: 1,1. ++ Biochemistry: Urea: 2,2 mmol/L, creatinine: 56 mmol/L, GOT: 61,9 U/L, GPT: 9,9 U/L. Albumin: 20,7 g/L. ++ Blood transfusion: 250 ml-2 unit. ++ Operation performed: Total gastrectomy, Roux en Y reconstruction, Left pancreatic spleenectomy. ++ The finding intra operation: Cyst communicated with gastric lumen by the hole mesured 3-5cm, the gastric cyst had mucosa linning and surrounded by muscle layer, mesured>10 cm in diameter, invaded the body and tail of pancreas and the rate. ++ Post operative recovery was normal. ++ Histopathologic finding: Immunohistochemistry: Inflamatory myofibroblastic tumor. Conclusion: We concluded that this was upper gastrointerinal bleeding from gastric duplication cyst   with massive volume in female patient, aged of 51 years old. The lesion was a tubular cyst, more than 10 cm in diameter,located in the greater curature of stomach, communicated with the gastric lumen by 3 cm hole. The surgical management included total gastrectomy with Roux en Y reconstruction, left pancreatic spleenectomy. Immunohistochemistry: Inflamatory myofibroblastic tumor