A case of advanced rectal cancer treated with chemotherapy after developing short bowel syndrome following emergency surgery for superior mesenteric artery embolism

Abstract

Introduction:While venous thrombosis is often associated with malignancy, arterial thromboembolisms are rare. We report a case of unresectable rectal cancer complicated by superior mesenteric artery (SMA) embolism, resulting in short bowel syndrome (SBS), but was successfully treated with chemotherapy. Case presentation:A 60-year-old woman with unresectable rectal cancer presented to our hospital with abdominal pain. Computed tomography revealed contrast defects originating from the SMA. In addition, CT demonstrated small intestinal wall disruption and free air. She was diagnosed with small intestinal ischemia and gastrointestinal perforation due to SMA embolism. Emergency small intestinal resection and jejunostomy were performed (operative time, 77 min; blood loss, 80 mL). The stoma was created 60 cm from the ligament of Treitz, resulting in the development of SBS. After stabilization with fluid management, a central venous port was placed. Chemotherapy was initiated, and the patient was discharged on postoperative day 29. The tumor shrank after completing four courses of chemotherapy. The patient received home parenteral nutrition and had nine courses of chemotherapy. Conclusions:This case suggests that the introduction of chemotherapy may be feasible and effective even in patients with SBS secondary to SMA embolism. SBS should not preclude chemotherapy in patients with malignant tumors. J. Med. Invest. 73 : 260-264, February, 2026