surgeon: Mark Pleatman, MD

Gastric Cancer - Metastasis

The patient is a 75 year-old man with a one year history of early
satiety and epigastric discomfort. He was treated initially
with antacids. He lost 16 pounds and was referred for
further evaluation. Endoscopy demonstrated a malignant
ulcerated tumor along the greater curvature of the body of
the stomach. CT scan was negative except for thickening of
the stomach and a small amount of free fluid in the pelvis.
He was taken to surgery for possible resection, but
laparoscopy was done first to rule out metastatic disease
that would make resection unwise.

Laparoscopy demonstrated obvious diffuse carcinomatosis,

with implants on all peritoneal surfaces. Here are
some on the abdominal wall.

This image shows implants on the surface of the liver.

Close-up view showing peritoneal implants, as well as

abnormal feeding blood vessels.

A punch biopsy is taken to confirm the diagnosis

At this point a decision was made to abandon plans for

resection. We decided to place a feeding jejunostomy
to facilitate nutritional support. The proximal
jejunum is being located.

The proximal jejunum has been located and grasped with

an instrument. An examining finger is palpating the
abdominal wall in preparation for making a small
incision to deliver the jejunum.

The jejunum is exteriorized. A jejunostomy tube is placed,

and the bowel is then returned to the abdomen and
sutured to the abdominal wall at the site of the
incision. The feeding tube is tunnelled to another site
and brought out, completing the procedure.