A 58-year-old fish dealer presented with epigastric pain. Radiographic and endoscopic studies showed a Borrmann type I gastric carcinoma on the anterior surface of the body of the stomach near the greater curvature, and a metastatic work-up demonstrated two masses in the right lobe of the liver (segment 6 and 8). The preoperative diagnosis was gastric carcinoma with liver metastasis (stage IV). At laparotomy no tumors were found in the left lobe of the liver or the peritoneum, and subtotal gastrectomy, D2 lymph node dissection, and segment 6 and 8 partial resection was performed. Ligation of the right portal vein and intraoperative common hepatic artery chemotherapy (one shot) was performed to destroy any non-visible metastatic tumors in the right lobe of the liver. Histologically, both the gastric and the hepatic lesions were adenocarcinoma. An aneurysm of the common hepatic artery developed after another shot of chemotherapy through the celiac artery one month after the operation. The aneurysm ruptured, and a small fistula formed between the aneurysm and the duodenum. The aneurysm was successfully treated by aneurysmectomy, and the perforated duodenal wall was managed by catheter duodenostomy. The patient is alive and pursuing his previous occupation with no evidence of tumor recurrence. He has been attending the outpatient clinic for follow-up every 6 months for 17 years since the operation. Removal of the primary and metastatic lesions with portal vein ligation and intra-arterial chemotherapy is therefore effective as an active measure to prolong the survival time of gastric carcinoma patients with metastases limited to a single lobe of the liver.
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