A Case of the Transverse Colon Cancer combined with Tumor Thrombus in Superior Mesenteric Vein and Colon Perforation

Akiyuki Kanzaki, Masashi Hirota, Kiichiro Okamoto, Katsuya Yamashita, Tsuyoshi Sato and Toru Ichihara

Department of Surgery, National Hospital Organization Toyohashi Medical Center

We report rare advanced colon cancer involving a tumor thrombus in the superior mesenteric vein and perforation. We completely resected the transverse colon cancer and obtained a good prognosis, although the superior mesenteric vein tumor thrombus had already perforated the colon. A 68-year-old man reporting abdominal distension from late September 2006 and admitted for continuous vomiting at the beginning of October was found in colonoscopy to have invasive colon cancer obstructing the transverse colon. After his colon was perforated on hospital day 6, we changed to emergency surgery. Preoperative enhanced CT showed a tumor thrombus in the superior mesenteric vein that had grown from the mesenteric vein around the tumor, with no liver metastasis. Intraoperative findings showed no stool contamination in the abdominal cavity, although the cecum was perforated and adhered to and was covered by the wall of the urinary bladder. The perforation had been caused by obstructive colitis on the oral side of the tumor. The main tumor was near the hepatic flexure without liver metastasis or peritoneal carcinomatosis. We conducted right hemicolectomy, opened the superior mesenteric vein, and completely removed the tumor thrombus. We then started and have continued with chemotherapy with no evidence of recurrence.

Key words
venous thrombosis, colon cancer, intestinal perforation

Reprint requests
Akiyuki Kanzaki Department of Surgery II, Nagoya University Graduate School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
January 28, 2009

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