Abstract
We herein report a rare case of an acute superior mesenteric vein (SMV) occlusion caused by a tumor thrombus from colon cancer, resulting in massive bowel infarction. A 60-year-old woman was referred to our hospital for evaluation of abdominal pain. Enhanced computed tomography (CT) showed an intraluminal filling defect in the SMV and an ascending colon tumor. We immediately began anticoagulant therapy and planned a colonoscopy. On the third day after admission, the patient went into shock. Emergency enhanced CT showed that the filling defect in the SMV had progressed to the portal vein (PV), and the small bowel was not extensively enhanced. Emergency surgery revealed that the small bowel was extensively necrosed (the non-necrosed portion was 40 cm in length) and that ascending colon cancer was present. The SMV and PV were occluded by the tumor thrombus. We performed massive small bowel resection, right colectomy, and thrombectomy with a Fogarty catheter. Both the colon cancer and the tumor thrombus in the SMV and PV were pathologically diagnosed as adenocarcinoma. Thus, we concluded the massive congestive bowel infarction was caused by the rapid progression of the tumor thrombus from the SMV to the PV. We continued the anticoagulant therapy postoperatively, and the SMV and PV were recanalized without residual bowel infarction or acute liver failure. The patient was discharged on postoperative day 47 with the assistance of intravenous hyperalimentation. She received chemotherapy, but died of multiple liver metastases and peritoneal dissemination 21 months postoperatively. SMV tumor thrombosis secondary to colon cancer can cause bowel infarction in patients undergoing anticoagulant therapy. In such cases, thrombectomy with a Fogarty catheter can effectively prevent bowel infarction and acute liver failure.
