Incidence of malignancy in gastric/antral perforation

Sumit Bhaskar, Priyanka Kumari, Sweta ., Dipendra K. Sinha


Background: Gastrointestinal perforation is one of the most commonly encountered cases in emergency department. Acute perforation of the stomach and duodenum causes significant morbidity and mortality. These perforations occur more commonly as a complication of peptic ulcer disease but in a few cases gastric cancer also present as gastric/antral perforation. Previously it was reported that approximately 10-16% of all gastric are caused by malignancy/gastric cancer. To study the incidence of malignancy in gastric perforation in present time, a study was carried out at our institute including all cases of gastric/antral perforations that presented to emergency department over a period of two years.

Methods: Cases of gastric/antral perforation that presented to our emergency were included in study. Biopsy from the margin of perforation was taken and sent for histopathological examination. Results obtained were further analysed with respect to total no. of cases, age, sex, personal habits and histopathological type.

Results: Out of total 60 cases that were included in study, biopsy report of 5 cases came to positive of malignancy.

Conclusions: The incidence of malignancy in gastric/antral perforation was found to be 8% in our study which shows a decline in this region as compared to incidence in the world.


Incidence, Malignancy, Gastric perforation

Full Text:



Adesunekami AR, Badnus TA, Ogundoin O. Causes an determinants of outcome of intestinal perforation in semi urben community. Ann Coll Surg. Hong Kong. 2000;7(4):116–23.

Norman SW, Christopher JKB, O'Connell PR. Bailey and Love’s Short practice of Surgery. 26th edition. 2013.

Ozmen MM, Zulfikaroglu B, Kece C, Aslar AK, Ozalp N, Koc M. Factors influencing mortality in spontaneous gastric tumour perforation. J Int Med Res. 2002;30(2):180-4.

Onnate–Ocana LF, Mendez Cruz G, Hernandez Ramos R, Becker M, Carillo JF, Herrera Goepfert R, et al. Experience in Surgical morbidity in patients with gastric carcinoma. Gastric Cancer. 2007;10(4):215-20.

Ozmen MM, Zulfikaroglu B, Kece C, Aslar AK, Ozalp N, Koc M, et al. Factors influencing mortality in spontaneous gastric tumour perforation. J Int Med Res. 2002:30(2):180-4.

Adachi Y, Mori M, Maehara Y, Matsumata T, Okudaira Y, Sugimachi K. Surgical reports of perforated gastric carcinoma: an analysis of 155 Japanese patients. Am J Gastroinerol. 1997;92(3):516-8.

Stechenberg L, Bunch RH, Anderson MC. The Surgical Therapy for perforated gastric cancer. Am Surg. 1981;47:208-10.

McNealy RW, Hedin RF. Perforation in gastric carcinoma. J Am Coll Surg. 1938;67:818-23.

Kennedy TL. Gastric Carcinoma and Acute perforation. Brit Med J. 1951;2:1489.

Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al. Schwartz’s Priciples of Surgery. 10th edition. McGraw-Hill Education.

Parkin DM, Pisani P, Ferlay J. Estimates of The Worldwide Incidence of 25 major cancers in 1990. Int Cancer. 1999;80:827.

Nomura A, Stemmermann G, Chyou P. Gastric cancer among the Japanese in Hawaii. Jpn J Cancer Res. 1995;86:916.

Williams NS, Bulstrode CJK, O'Connell PR (eds). Bailey and Love's Short Practice of Surgery. 26th edition. Boca Raton, FL: CRC Press; 2013: 1517.

Parkin DM , Pisani P, Ferlay J. Estimates of The Worldwide Incidence of 25 major cancers in 1990. Int Cancer. 1999;80:827.

Mohandas KM, Nagral A. Epidemiology of digestive tract cancers in India II. Stomach and Gastrointestinal lymphomas. Ind J Gastroenterol. 1998;17:24.

Malhotra SL. Geographical distribution of gastrointestinal cancers in India with special reference to causation. Gut. 1967;8:361-72.

Sumathi B, Ramalingam S, Navaneethan U, Jayanthi V. Risk Factors for gastric acncer in South India. Singapore Med J. 2009:50:147-51.

Phukan RK , Zomawia E, Hazarika NC, Baruah D, Mahanta J. High prevalence of stomach cancer among the people of Mizoram, India Curr Sci. 2004:87:285-6.

Phukan RK, Zomawia E, Narain K, Hazarika NC, Mhanta J. Tobacco use and stomach cancer in Mizoram, India. Cancer Epidemiological Markers Prey. 2005;14:1892-6.

Chow W, Swanson C, Liowska J. Relation of gastric cancer in relation to consumption of cigarettes, alcohol, tea and coffeein warsaw Poland. Int J Cancer. 1999;81:871.

Ye W, Ekstrom A, Hansson L. Tobacco, Alcohol and the risk of gastric cancer by sub type and histologic type. Int J Cancer. 2000;83:223.

Zaridze D, Borisowa E, Maximovitch D. Alcohol consumption, smoking and risk of gastric cancer: case control study from Moscow, Russia. Cancer Causes Control. 2000;11:363.

Huang JQ, Sridhar S, Hunt RH. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology. 1998;114:1169.

Uemura N, Okamoto S, Yamamoto S. Helicobacter pylori infection and development of gastric cancer. N Eng J Med. 2001;345-784.

Gertsch P, Yip SKH, Chow LWC, Lauder IJ. Free perforation of gastric carcinoma. Results of surgical treatment. Arch Surg. 1995;130:177-81.

Lehnert T, Buhl K, Dueckm, HInz U, Herfarth C. Two staged radical gastrectomy for perforated gastric cancer. Eur J Surg Oncol. 2000;26:780-4.

Ergul F, Gozetlik FO. Emergency spontaneous gastric gastric perforations: ulcus versus cancer. Langenbecks Arch Surg. 2009;394(4):643-6.

Kandel BP, Singh Y, Singh KP, Khakurel M. Gastric cancer perforation: experience from a tertiary care hospital. J Nepal Med Assoc. 2013;52(191):489-93.

Roviello F. “Perforated gastric carcinoma, a report of 10 cases and review of literature”. World J Surgical Oncol. 2006;4:19.

Tan KK, Quek TL, Wong N, Li KK, Lim KH. Emergency surgery for perforated gastric malignancy: an institutional experience and review of literature. J Gastrointestinal Oncol. 2011;2(1):13-8.

Ignjatovic N, Stojanov D. Perforation of gastric cancer, what should the surgeon do. Bosn J Basic Med Sci. 2016;16(3):222-6.