A CASE OF HETEROCHRONOUS DOUBLE CANCER OF THE RECTUM AND STOMACH ASSOCIATED WITH SUPERIOR MESENTERIC ARTERIAL EMBOLISM

Recent experience with heterochronous double cancer of the rectum and stomach in a 67-year-old man, associating with superior mesenteric arterial embolism in the course of observation which could be successfully managed by extensive excision of the intestine, is described. the patient was admitted to the hospital because of severe abdominal pain. There were previous histories of having a rectal cancer which was treated by low anterior excision 5 years before and an early gastric cancer 3 years before, for which the patient denied to be treated. Laparotomy was carried out within 5 hours after the onset of the pain. During surgery, necrotizing lesions extending from the duodenal horizontal portion to entire the small intestine, and from the ileocecal region to remnant sigmoid colon were found. Partial excision of the duodenum, total excision of the small intestine, and extended excision of the colon were performed. Reconstruction was impossible and gastrostomy was made. Resected specimen showed a thrombolic embolism caused by a thrombus at the root of superior mesenteric artery. After surgery the patient was able to take fluids in the combinative use of IVH, but the impaired hepatic function and jaundice were aggravated. He died of MOF on the 42nd postoperative day. It is indicated that, if laparotomy can be performed in an early period after the onset of the disease, and if every effort is made to prevent shock and MOF after surgery, we can expect a long survival in these patients even though extended excision of the intestine can not be avoided.