Case Report
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World J Gastrointest Pathophysiol. Feb 15, 2011; 2(1): 15-18
Published online Feb 15, 2011. doi: 10.4291/wjgp.v2.i1.15
Right colon cancer presenting as hemorrhagic shock
Tomoyuki Iwata, Kazuo Konishi, Takahisa Yamazaki, Katsuya Kitamura, Atsushi Katagiri, Takashi Muramoto, Yutaro Kubota, Yuichiro Yano, Yoshiya Kobayashi, Toshiko Yamochi, Nobuyuki Ohike, Masahiko Murakami, Takehiko Gokan, Nozomi Yoshikawa, Michio Imawari
Tomoyuki Iwata, Kazuo Konishi, Takahisa Yamazaki, Katsuya Kitamura, Atsushi Katagiri, Takashi Muramoto, Yutaro Kubota, Yuichiro Yano, Yoshiya Kobayashi, Michio Imawari, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Nobuyuki Ohike, First Department of Pathology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Toshiko Yamochi, Second Department of Pathology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Masahiko Murakami, Division of Gastroenterogical Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Takehiko Gokan, Department of Radiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
Nozomi Yoshikawa, Endoscopic Center, Showa University Hospital, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
Author contributions: Iwata T, Konishi K, Yamazaki T, Kitamura K, Katagiri A, Muramoto T, Kubota Y, Yano Y, Kobayashi Y, Yamochi T, Ohike N, Murakami M, Gokan T, Yoshikawa N and Imawari M analyzed the patient’s data; and Iwata T and Konishi K wrote this case report.
Correspondence to: Kazuo Konishi, MD, PhD, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. konishimd@med.showa-u.ac.jp
Telephone: +81-3-37848535 Fax: +81-3-37847553
Received: August 6, 2011
Revised: October 28, 2011
Accepted: November 4, 2011
Published online: February 15, 2011
Abstract

A 67-year-old man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock. An abdominal computed tomography scan revealed a large mass in the ascending colon invading the duodenum and pancreatic head as well as extravasation of blood from the gastroduodenal artery (GDA) into the colon. Colonoscopy revealed an irregular ulcerative lesion and stenosis in the ascending colon. Therefore, right hemicolectomy combined with pylorus-preserving pancreaticoduodenectomy was performed. Histologically, the tumor was classified as a moderately differentiated adenocarcinoma. Moreover, cancer cells were mainly located in the colon but had also invaded the duodenum and pancreas and involved the GDA. Immunohistochemically, the tumor cells were positive for cytokeratin (CK)20 and carcinoembryonic antigen (CEA) but not for CK7 and carbohydrate antigen (CA)19-9. The patient died 23 d after the surgery because he had another episode of arterial bleeding from the anastomosis site. Although En bloc resection of the tumor with pancreaticoduodenectomy and colectomy performed for locally advanced colon cancer can ensure long-term survival, patients undergoing these procedures should be carefully monitored, particularly when the tumor involves the main artery.

Keywords: Colon cancer; Hemorrhagic shock; Adjacent organs invasion; En bloc resection; Complication