A Case of Protein S Deficiency Presented with Necrosis of a Reconstructed Colon after Surgery for Esophageal Cancer

Abstract

The patient was a 68-year-old man who was diagnosed with esophageal and gastric cancer by an esophagogastroduodenoscopy at a periodic health examination, and he was scheduled to receive neoadjuvant chemotherapy followed by radical surgery for esophageal cancer according to the standard therapeutic guidelines at that time. We performed thoracoscopic esophagectomy, total gastrectomy, and ante-thoracic route reconstruction of the colon as the radical surgery. On the 4^th postoperative day, an esophagogastroduodenoscopy disclosed necrosis of the reconstructed colon, for that we performed enucleation of the reconstructed colon and esophagostomy. Intraoperative findings included the lifted colon to have necrosed throughout the almost full length of the colon and the inside of the mesenteric vessel to have thrombosed throughout the almost full length of the vessel. Close examinations of various coagulation activities revealed the protein S activity of 33%. Finally congenital protein S deficiency was diagnosed.

It is considered that necrosis of the reconstructed colon might be caused by participation of protein S deficiency that was clarified after surgery. In performing surgery, we should bear in mind that some patients can have a hereditary blood clotting problem in a certain degree.