Young gastric cancer patient with high CA19-9 complicated by Trousseau syndrome.

A 47-year-old Japanese woman presented with epigastric discomfort and anorexia. Upper endoscopy showed type 4 advanced gastric cancer in the gastric antrum with stenosis of the pyloric portion. Abdominopelvic CT revealed peritoneal dissemination, and stage IV advanced gastric cancer was diagnosed. Laparoscopic gastrojejunostomy and enterostomy were performed. Trousseau syndrome occurred 7 days post-surgery. Despite appropriate treatment, the patient developed a pulmonary embolism 13 days later and died 18 days post-surgery. Even in young cancer patients without lifestyle disease complications, it is important to pay attention to Trousseau syndrome as part of cancer management.

Two cases of accidental ingestion of a press-through package (PTP) sheet, diagnosed by tomosynthesis prior to endoscopy.

The accidental ingestion of a press-through package (PTP) sheet is associated with the risk of gastrointestinal injury and puncture. When pain occurs in the laryngeal pharynx, the PTP may already be stuck in the upper esophageal region, and urgent endoscopic treatment is necessary. A plain chest X-ray image should be performed first to identify the ingested PTP, but this was not successful in the present two patients. As a next step, a CT scan (which involves high radiation exposure) is commonly used. In our patients (a 76-year-old woman and a 59-year-old man), tomosynthesis was used to confirm the presence and location of a PTP sheet as a pre-endoscopic diagnosis. With tomosynthesis, the level of radiation exposure was reduced to approx. 1/10 of that of simple CT; the imaging time is also shorter at ~ 5 s. Tomosynthesis can be performed at approx. 1/3-1/4 the cost of simple CT. The usefulness of tomosynthesis as a pre-endoscopic diagnostic tool was demonstrated in our patients, and its further utilization is expected.