Abstract
A 64-year-old man complained of general fatigue and dizziness. He was malnourished and had a large protruding gastric body tumor. He had foul eructations, unrelenting diarrhea, severe trunk emaciation, and edema of his extremities. A gastrocolic fistula originating from a transverse colon cancer was found, as well as a synchronous advanced rectal cancer (Rb). Neither total parenteral nutrition nor enteral nutrition improved his nutritional status. He underwent a left colectomy, a sleeve gastrectomy, a splenectomy for en bloc tumor resection ; an end transverse colostomy and a mucous fistula of the descending colon were constructed. On the 49th -postoperative day, he underwent a Hartmann operation for rectal cancer. On histology, each tumor included identical well differentiated adenocarcinoma with regional lymph node metastases along the inferior mesenteric artery. After the second operation, the patient was given chemotherapy (mFOLFOX6) for the metastatic liver tumor lesion with tumor thrombus in the portal vein. The patient died of multiple liver and distant lymph node metastases 5 years and 4 months after the first operation.
