Distal Gastrectomy under Management of Intra-Aortic Balloon Pumping Therapy for an Elderly Patient with Carcinomatous Pyloric Stenosis Complicated by Severe Coronary Stenosis

This case involved an 82-year-old man with a history of diabetes mellitus and myocardial infarction. He was undergoing treatment with 2 oral antiplatelet agents. The patient presented to our hospital for carcinomatous pyloric stenosis caused by type 4 advanced gastric cancer. Although distal gastrec...

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Bibliographic Details
Published inGan to kagaku ryoho Vol. 49; no. 13; p. 1625
Main Authors Yamano, Masatoshi, Nemoto, Hiroshi, Tsumuraya, Naoko, Harigane, Kohei, Tamura, Yoshimi, Komori, Hiromasa, Miyaji, Hajime, Sarukawa, Hideki, Wakabayashi, Tetsuji, Yazawa, Naoki, Shimura, Kunihiko, Miyamae, Taku
Format Journal Article
LanguageJapanese
Published Japan 01.12.2022
Subjects
Activities of Daily Living
Aged
Aged, 80 and over
Coronary Artery Disease
Coronary Stenosis
Gastrectomy
Heart Diseases
Humans
Intra-Aortic Balloon Pumping
Male
Pyloric Stenosis - etiology
Pyloric Stenosis - surgery
Stomach Neoplasms - complications
Stomach Neoplasms - surgery
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Summary:This case involved an 82-year-old man with a history of diabetes mellitus and myocardial infarction. He was undergoing treatment with 2 oral antiplatelet agents. The patient presented to our hospital for carcinomatous pyloric stenosis caused by type 4 advanced gastric cancer. Although distal gastrectomy was planned, preoperative coronary angiography revealed triple- vessel coronary artery disease. Therefore, surgery was performed under management of intra-aortic balloon pumping (IABP)therapy. The patient's hemodynamics at the time of the operation were stable, and no perioperative cardiovascular complications occurred. However, the patient was not able to start an oral diet because of impaired swallowing function. Although he underwent daily swallowing rehabilitation, he died of aspiration pneumonia 40 days postoperatively. There are many reports of cancer resection under IABP management for patients with severe heart disease. Because the perioperative hemodynamics were stable in all 21 reported cases of digestive malignant tumor resections in Japan, an IABP is suggested to be very effective for patients with severe heart disease. However, early death has also occurred, as in the present case. Close attention to the indications for IABP therapy is needed, especially in elderly patients, in consideration of not only cancer and heart disease but also preoperative activities of daily living.
ISSN:0385-0684