A 57-year-old male patient was admitted to our unit of General Surgery with a recent diagnosis of ulcerated gastric angulus adenocarcinoma. In anamnesis he reported a history of emphysematous chronic obstructive pulmonary disease (COPD), previous appendectomy and laparoscopic suture repair of perforated gastric ulcer.
The patient reported a weight loss of about 15 kg in the last 12 months associated with abdominal discomfort, heartburn and repeated vomiting episodes. A gastroscopy was performed and a 25 mm ulcerated lesion with irregular edges was revealed at the gastric angulus towards the antrum. Biopsy confirmed a high grade dysplasia associated to adenocarcinoma. No metastatic disease was detected at the staging chest-abdomen CT scan and no clear imaging compatible with parasite bowel infection was detected. The physical examination revealed a state of under-nutrition and tender abdomen; laboratory values were normal. To complete the pre-operative phase, a pharyngeal swab for testing SARS-CoV-2-PCR was performed and a negative result was obtained. After multidisciplinary discussion and preoperative evaluation, the patient was operated from a skilled surgeon on full robotic subtotal gastrectomy with double loop Roux-en-Y reconstruction with standard D2 lymphadenectomy (according to JGCA 2011 gastric cancer classification, 2017 NCCN gastric cancer guidelines) with the application of the da Vinci Si system (Intuitive Surgical Inc, Sunyvale, CA, USA). No intraoperative complications were registered and blood loss were minimal; two abdominal drains were placed and nasogastric tube was removed before awakening. In the immediate post-operative time, about 10 h from the end of surgical intervention, the patient presented with vomiting and siero-ematic material with a single, 5 m-long, yellowish-white colored, elastic, motile tenia and one knot were observed (Fig. 1). At the parassitological analysis it resulted in Taenia Saginata; a strobilus with a high number of proglottids and eggs were identified and no scolex was clearly detected. After consultation with infectious disease team, as soon as the oral intake restarted in fourth postoperative day (POD), a 3 days-therapy with single oral dose albendazol (400 mg) therapy was achieved and a progressive disappearance of eggs in the stools was registered till negative parasitological stools research was obtained. After a new medical interview the patient reported occasional episode of evacuation of filamentous stools and he assumed that he usually did not eat uncooked meat even if he couldn't be sure that it was never happened.
During the postoperative hospital stay, in fourth POD, a water-soluble-contrast upper gastrointestinal X-ray imaging was performed and gastrointestinal outflow resulted regular in absence of anastomotic leakage.
In sixth POD the patient presented with fever and blood exams revealed an increase in C reactive-protein rate (28 mg/dl) with normal white blood cells count. To exclude Covid-related pneumonia, second pharyngeal swab for testing SARS-CoV-2-PCR was repeated, resulted negative; a chest-abdomen CT scan was performed and posterior basal bilateral segments pneumonia without abdominal abnormalities was described. An intravenous broad spectrum empiric antibiotic therapy was added leading to clinical improvements; a high caloric fractionated diet was optimizated and the patient was than discharged in 13th POD.
The histological examination of the tumor revealed a poorly differentiated both intestinal and signet ring cell carcinoma, 57 lymphnodes were harvested and none metastasis were found (pT1b; pN0; pMx; pR0 according to AJCC 8th edition).