What happened, in summary

A 67-year-old man arrived in the emergency department with severe chest pain, shortness of breath and chills after a month of nausea, vomiting and swallowing difficulty. He had unintentionally lost about 90 pounds over the previous year. CT showed an esophageal perforation together with thickening at the gastric pylorus.

Emergency endoscopy found a large distal esophageal perforation, a stomach full of retained food and fluid, and an ulcerated prepyloric mass. He required drainage, an esophageal stent and intensive treatment for septic shock. A temporary pyloric stent was later placed to relieve the gastric outlet obstruction. Repeat biopsy confirmed adenocarcinoma.

Once he was stable and imaging showed no distant metastatic disease, he underwent distal gastrectomy with Billroth II reconstruction. Pathology showed a 1.8 cm moderately differentiated gastric adenocarcinoma with negative margins and cancer in 2 sampled lymph nodes.

His recovery required nearly 3 months of hospitalization for infection control, nutrition and rehabilitation. By the latest update he was eating a regular diet and walking independently. He had been referred to medical and radiation oncology to consider adjuvant therapy.