PMC7388164_01
a) Colonoscopy revealed a type 2 tumor and circular stenosis in the ascending colon. The colonoscopy was unable to pass the lesion. b) Gastrografin enema revealed stenosis observed in the ascending colon.
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Total colonoscopy revealed a protruding mass and circular stenosis in the ascending colon that almost obstructed the lumen (Fig. 1).
a) Dynamic CT revealed an intraluminal filling defect extending from the ICV to the SMV. There was no blood flow in the SMV with the tumor thrombus. b.c) On 3D-CT-reconstructed vascular images, the green lesion is the tumor thrombus. The shape of the tumor thrombus extended from the ICV to the SMV over a distance of 3.3 cm, including the second jejunal vein.
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Dynamic CT revealed an enhanced mass in the ascending colon, a right iliopsoas abscess near the mass and an intraluminal filling defect extending from the ICV to the SMV (Fig. 2a).
Intraoperative findings. a,b) To avoid the movement of cancer fragments during surgical resection, initial ligation of the SMV with the tumor thrombus is ideal. c) Even after clamping the SMV at the proximal end of the tumor thrombosis for 30 min, the small intestine showed no ischemic or congestive changes. d) We ligated the proximal and distal sides of the SMV with the tumor thrombus.
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The patient underwent right hemicolectomy with D3 lymphadenectomy and combined resection of the SMV (Fig. 3).
a) We confirmed good perfusion of intestinal artery blood flow using the NIR camera system after ICG injection. b) The small intestine showed no ischemic or congestive changes under the direct visualization. The macroscopic intestinal finding was normal during the almost 8 h operation.
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We clamped the SMV above the proximal side of the tumor thrombosis for 30 min and used intraoperative ICG fluorography for evaluation of the intestinal blood flow (Fig. 4).
a) Pathological findings. There was a type 2 tumor of the ascending colon. b) White-colored tumor thrombus continuously filling from the ICV to the SMV. Histological findings revealed a tumor thrombus in the SMV. c) Tumor thrombus consisting of metastatic adenocarcinoma cells in the background.
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The resected venous portion from the ICV to the SMV was filled with white tumor thrombus (Fig. 5a, b). The tumor thrombus consisted of metastatic adenocarcinoma cells in the background (Fig. 5c).