Mesenteric ischemia after capecitabine treatment in rectal cancer and resultant short bowel syndrome is not an absolute contraindication for radical oncological treatment
Thrombotic events, arterial or venous in origin, still remain a source of substantial morbidity and mortality in cancer patients. The propensity for their development in oncology patients is in part a consequence of the disease itself and in part a result of our attempts to treat it.
One of the rarest and deadliest thromboembolic complications is arterial mesenteric ischemia. The high mortality rate stems in part from its rarity and in part from its non-specific clinical presentation, both of which make early diagnosis and treatment difficult. Hence, most diagnoses and treatments occur late in the course of the disease.
One of the issues survivors of arterial mesenteric ischemia may face is short bowel syndrome, which has become a chronic condition after the introduction of parenteral nutrition at home.
We present a case of a 73-year-old rectal cancer patient who developed acute arterial mesenteric thrombosis at the beginning pre-operative radiochemotherapy. Almost the entire length of his small intestine, except for the proximal 50 cms, and the ascending colon had to be resected. After multiorgan failure his condition improved, and he was able to successfully complete radical treatment (preoperative radiotherapy and surgery) for his rectal carcinoma, despite developing short bowel syndrome (SBS) and being dependent upon home-based parenteral nutrition to fully cover his nutritional needs.