Gastric Adenocarcinoma in a Young Nigerian – A Case Report

Abstract Gastric adenocarcinoma is uncommon among young Nigerians. We present Mrs O.V. a 41year old Nigerian who presented with one year history of recurrent epigastric pain that was peppery/burning in nature, non-radiating, aggravated by eating and temporarily relieved with the use of antacids. There is associated progressive weight loss and secondary amenorrhea since the onset of her illness. She started vomiting two weeks prior to presentation which was non-projectile, containing both recently ingested meals and partially digested stale food substances, vomitus was non-bilous. Episodes of vomiting is usually preceded by abdominal bloating or feeling of indigestion. Clinical examination revealed a chronically ill-looking young woman with a positive succussion splash on abdominal examination. Examination of the other systems was normal. Provisional diagnosis was suspected Chronic Gastric Antral Ulcer complicated by Gastric Outlet Obstruction to rule out Gastric Antral Adenocarcinoma. Abdominal ultrasound and CT scans showed features consistent with Gastric Outlet Obstruction. Upper GI Endoscopy revealed Gastric Antral Adenocarcinoma with Duodenal extension and Chronic Duodenal Ulcer complicated by Gastric Outlet Obstruction. Histology showed well differentiated Gastric Antral Adenocarcinoma. She had a Bilroth II procedure(Partial Gastrectomy and Gastro-Jejunostomy)and was commenced on adjunct chemotherapy: FAM regimen(5-Fluorouracil, Adriamycin and Mitomycin). She was also placed on long term proton pump inhibitor therapy. She has sustained remarkable clinical improvement with resolution of all her initial symptoms and she is currently on regular clinic follow-up. More cases of Gastric Adenocarcinoma among young Nigerians are being reported. There is a need for more extensive studies on this and possibly an indication for commencing endoscopy screening at an earlier age among individuals presenting with recent onset dyspepsia. Key words: Gastric, Adenocarcinoma, Young, Nigerians.