Gastrectomía total de emergencia por linfoma gástrico perforado en peritonitis generalizada. Reporte de caso Emergency total gastrectomy for perforated gastric lymphoma in generalized peritonitis. Case report

ABSTRACT Gastric perforation as the initial presentation of non-Hodgkin Lymphoma (NHL) is an uncommon surgical emergency that presents a dilemma between damage control surgery and definitive oncological surgery in a single stage. We present the case of a 69-year-old male patient with a presumptive endoscopic diagnosis of Borman II gastric adenocarcinoma, who was admitted with an acute abdomen secondary to massive pneumoperitoneum. Emergency laparotomy revealed generalized peritonitis with two gastric perforations of tumor-like appearance, measuring 8x6 cm and 4x3 cm, which precluded primary closure. Therefore, total gastrectomy with primary Roux-en-Y reconstruction was performed. The final biopsy result reported ulcerated diffuse large B-cell NHL. The postoperative course was complicated by a low-output esophagojejunal anastomotic leak, with a failed attempt at self-expandable stent placemente, ultimately managed conservatively with a nasoenteric tube and total parenteral nutrition, and a clinical picture suggestive of pulmonary thromboembolism, which was not confirmed by CT angiography due to inatitutional unavailability. The patient died on the ninth postoperative day from multiple organ failure. This case highlights the technical feasibility of radical surgery in a septic setting when no other reconstructive option exists, the importance of the histopathological differential diagnosis of gastric lymphoma, and the continued relevance of non-operative management of high anastomotic leaks in centers without access to advanced interventional endoscopy.