What happened, in summary

An 81-year-old woman presented with weakness, weight loss, vomiting, abdominal pain and anemia. A swelling near a previous abdominal incision progressed to a skin ulcer and then a fistula. CT showed a very large tumor arising from the gastric antrum and directly invading the transverse colon and abdominal wall, without distant metastases identified on imaging.

She underwent extensive en bloc surgery removing the involved stomach, transverse colon and abdominal wall, together with systematic lymph-node dissection. The large abdominal-wall defect was reconstructed using a biological prosthesis and reverse abdominoplasty. Pathology showed poorly differentiated gastric adenocarcinoma with neuroendocrine differentiation; tumor cells were positive for chromogranin and CD56.

Her early postoperative recovery was initially satisfactory. On day 10, however, she developed severe respiratory distress and pneumonia. Despite antibiotics and transfer to intensive care, she died 20 days after surgery.