Recurrent gastric cancer with peritoneal spread and a difficult intestinal fistula

What happened, in summary

A 74-year-old woman had undergone total gastrectomy for advanced gastric cancer about 10 years earlier. The original tumor had penetrated the outer stomach wall, with no regional lymph-node or distant metastasis observed at surgery. She then completed 1 year of S-1 chemotherapy.

Years later the gastric cancer recurred with peritoneal dissemination. She underwent three abdominal operations, including intestinal resection, bypass and ileostomy. After the third operation, a connection formed between the jejunum and the abdominal wall, creating a persistent jejunocutaneous fistula. Fasting and drainage did not stop the leakage, and she became severely malnourished with electrolyte problems. She was initially considered too frail for another operation.

An endoscopic stent was placed across the intestinal stricture and fistula. Leakage stopped, she resumed oral intake after 1 week, and the skin opening closed within a month. Her nutrition and inflammation improved. She later developed bowel obstruction from adhesions and worsening peritoneal disease and underwent another operation. The stent was removed during that surgery. The terminal gastric cancer continued to progress, and she died 3 months later, about a decade after her original gastrectomy.