Perforated gastric schwannoma treated with laparoscopic wedge gastrectomy: a rare case report

Introduction: Gastric schwannomas are rare benign mesenchymal tumors, accounting for approximately 0.2% of all gastric tumors. They are usually asymptomatic, and tumor perforation is extremely uncommon. We report a rare case of a gastric schwannoma complicated by perforation that was successfully treated with laparoscopic wedge gastrectomy following conservative therapy. Presentation of the case: A 55-year-old woman presented with abdominal pain and fever. Laboratory findings revealed leukocytosis, anemia, and elevated C-reactive protein levels. Computed tomography demonstrated a 62-mm exophytic gastric mass with perforation and localized abscess formation. Intravenous antibiotics led to resolution of her acute symptoms, and subsequent imaging confirmed improvement. Upper gastrointestinal endoscopy revealed a submucosal tumor with ulceration, and biopsy with immunohistochemistry (KIT-negative, S-100 positive) confirmed gastric schwannoma. Given the large tumor size and history of perforation, laparoscopic wedge gastrectomy was performed. Although omental adhesions surrounding the tumor were observed intraoperatively, complete resection was achieved with preservation of luminal integrity. Pathological examination confirmed schwannoma with low proliferative activity. The postoperative course was uneventful, and the patient remained recurrence-free at 6 months. Clinical discussion: Although gastric schwannomas are generally benign and slow-growing, large tumors and associated ulceration may contribute to the risk of perforation. Reports of perforated gastric schwannomas are extremely limited, and optimal management strategies remain unclear. Conclusion: To the best of our knowledge, this is the first reported case of a perforated gastric schwannoma treated by laparoscopic resection. This case suggests that laparoscopic wedge gastrectomy is a feasible treatment option for a perforated gastric schwannoma after appropriate control of local inflammation.