Gastric perforation repaired by hepatic round ligament

Rationale: Gastric perforation is a rare but life-threatening complication of gastric cancer, often presenting with acute peritonitis and requiring emergent surgical repair. The conventional treatment relies on an omental patch (Graham’s technique); however, this approach is not always feasible, particularly in patients with advanced disease or omental involvement. Patient concerns: We report the case of a 44-year-old male with advanced gastric adenocarcinoma complicated by peritoneal carcinomatosis who presented with acute abdomen following stent insertion. Diagnosis: Imaging confirmed gastric perforation and generalized peritonitis. Interventions: During emergent laparoscopic exploration, the omentum was unsuitable due to carcinomatous infiltration. Instead, the hepatic round ligament was mobilized and used as a patch to seal the perforation, achieving effective closure. The patient initially recovered well postoperatively; however, he later deteriorated due to progression of his underlying malignancy and died on postoperative day 16. Outcomes and lessons: This case highlights the hepatic round ligament as a viable alternative to the omentum in repairing gastric perforations, particularly in malignant or hostile abdominal environments. Wider application of this technique warrants further study to establish its safety and long-term outcomes.