# Emergency total gastrectomy for gastric perforation secondary to metastatic lobular breast cancer: a case for aggressive surgical intervention in select patients

## TL;DR

A 67-year-old woman with metastatic breast cancer underwent emergency stomach removal after a rare complication involving the stomach, showing that aggressive surgery can be beneficial in specific cases.

## Contribution

This is the first reported case of emergency total gastrectomy for gastric perforation caused by metastatic lobular breast cancer.

## Key findings

- Emergency total gastrectomy was successfully performed for gastric perforation due to metastatic lobular breast cancer.
- The patient recovered well post-surgery despite a minor complication.
- The case suggests aggressive surgical intervention may be appropriate in select metastatic presentations.

## Abstract

Breast cancer remains a predominant contributor to cancer-related morbidity and mortality among women worldwide. Invasive lobular carcinoma (ILC), the second most prevalent histological subtype, exhibits a distinctive propensity for diffuse infiltration and distant metastases, including rare involvement of the gastrointestinal tract. We describe a case of acute gastric perforation secondary to metastatic ILC in a 67-year-old woman with recurrent Luminal A disease. Her prior treatment included wide local excision, adjuvant chemoradiotherapy, and salvage mastectomy. Emergent imaging revealed gastric perforation with diffuse intraperitoneal fluid. Following multidisciplinary discussion and in accordance with the patient’s wishes, an R1 total gastrectomy was performed with palliative intent. The patient recovered well, despite a minor duodenal stump leak managed conservatively. She was subsequently discharged for ongoing oncological management. To our knowledge, this is the first reported case of emergency total gastrectomy for ILC-related gastric perforation, highlighting the potential role of aggressive surgical intervention in select individualized metastatic presentations.