Emergency spontaneous gastric perforations: ulcus versus cancer

Background  The spontaneous perforation of gastric cancer is a rare fatal complication, occurring in 1% of patients with gastric cancer, and it has a wide hospital mortality range (0–82%). In addition, it has been reported that about 10–16% of all gastric perforations are caused by gastric carcinoma. The aim of this study is to evaluate the gastric perforations and improve an alternative pathway for the management of this disorder when a pathologist is not available. Material and methods  We reviewed the medical records of 513 patients who had undergone surgical treatment for gastric perforation due to gastric ulcus or gastric carcinoma in two medical centers. Sixty-seven (13.06%) patients were treated for perforated gastric carcinoma. Perforations due to trauma and iatrogenic causes were excluded. The clinicopathologic features of all patients were analyzed on the basis of their medical records. Results  According to the results of our analysis, we can suggest that if a patient with gastric perforation has an age more than 60 years, an ulcus diameter (with edema) more than 6 cm, a perforation diameter more than 0.5 cm, a symptom duration of more than 20 h, and a white blood cell count less than 15.10³/μL, he might have a gastric carcinoma. This system has a specificity of 98.7%, a sensitivity of 53.7%, a negative predicted value of 93.4%, and positive predicted value of 85.7%. Conclusion  The diagnosis of malignancy is often made only on postoperative or operative frozen pathologic examination. We suggest a new pathway for the gastric perforations, if a pathologist is not available during the operation.