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

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.