PMC5301121_01
Esophagogastroduodenoscopy image from the first hospitalization. Esophagogastroduodenoscopy shows a tumor and food debris in the stomach.
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F1
Following admission to our hospital, we performed an EGD that showed copious gastric food debris and a tumor involving the entire stomach (Fig 1).
Computed tomography images. Computed tomography performed on the 7th day of the second cycle of the chemotherapy shows perforation (red arrow) at the lesser curvature of the gastric body (a). Computed tomography performed on the 27th hospital day of the second hospitalization shows the fluid collection (yellow arrow) outside the stomach (b).
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F2
A CT examination showed perforation at the lesser curvature of the gastric body (Fig 2a), and he was readmitted to our hospital. A CT examination on the 27th hospital day showed enlargement of the fluid collection outside the stomach (Fig 2b).
Endoscopic ultrasound-guided drainage performed on the 27th hospital day of the second hospitalization. Endoscopic ultrasonography reveals an anechoic lesion outside the stomach. A 19-gauge needle is present aspirating the lesion (a). A fluoroscopic image shows the 6-Fr pigtail nasal biliary catheter placed in the lesion (b).
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F3
Because malodorous yellowish-white pus was aspirated, we diagnosed the lesion as an intra-abdominal abscess and conducted EUS-guided drainage (Fig 3a). The fistula was dilated using a dilation catheter (ES dilator; Zeon Medical, Tokyo, Japan), and a 6-Fr pigtail nasal biliary catheter (nasal biliary drainage set; Cook Medical, Bloomington, IN, USA) was subsequently placed (Fig 3b).