Spontaneous gastroduodenal perforation in cancer patients receiving chemotherapy

Abstract

Background/aims: Spontaneous gastroduodenal perforation is a rare and lethal complication in cancer patients receiving chemotherapy.

Methodology: Data of 9 patients with spontaneous gastroduodenal perforation occurring during chemotherapy were reviewed.

Results: All 9 patients were male with an average age of 54.4+/-2.5 years. The primary malignancies included 5 head and neck cancers, 2 esophageal cancers, 1 malignant lymphoma, and 1 hepatocellular carcinoma. Abdominal pain was the most common symptom. The average interval between the onset of symptoms and surgery was 2.9+/-0.7 days (range: 16 hours to 7 days). Perforation was located on the duodenum (6 patients) and on the lower part of the body of the stomach (3 patients). Simple closure of the perforation was performed on 8 patients, and subtotal gastrectomy on 1 patient. Culture of the ascitic fluid of 8 patients revealed E. coli, Klebsiella pneumoniae, streptococcus viridans, and enterococcus. Four patients (44.4%) had post-operative complications. The 30-day post-operative mortality was 44.4% (4/9). Three patients died of sepsis with multiple organ failure, and 1 died of hepatic failure. Age, anaemia, leukopenia, serum albumin levels, impaired renal or liver functions are not significant operative risk factors. Pre-operative shock is a significant factor in predicting operative mortality and complications.

Conclusions: High index with suspicion of the disease with early treatment may improve survival of cancer patients with spontaneous gastroduodenal perforation.