Postoperative Disseminated Intravascular Coagulation in a Patient With Ureteral Metastasis from Gastric Cancer

Hsin-Chih Yeh, Hsi-Lin Hsiao, Tu-Hao Chang, Sheng-Lan Wang, Chun-Hsiung Huang, Wen-Jeng Wu
2008 Kaohsiung Journal of Medical Sciences  
Tumor metastases to the ureter are infrequent and are usually diagnosed during postmortem examinations [1, 2] . Gastric cancer is an unusual primary tumor to metastasize to the ureter [1] [2] [3] [4] . Acute disseminated intravascular coagulation (DIC) is a rare but severe complication of gastric cancer, and almost all patients die within 1-3 weeks of developing DIC [5, 6] . We report the case of a patient who developed acute DIC after surgical resection of a metastatic ureteral tumor derived
more » ... ral tumor derived from gastric signet ring cell carcinoma. CASE PRESENTATION A 66-year-old man suffered from intermittent, dull abdominal pain in the left lower abdomen for 3 months and was admitted to the gastroenterological surgery department for evaluation. He had a history of subtotal gastrectomy for gastric cancer nearly 3 years previously, and histologic diagnosis was signet ring cell carcinoma, stage T4N1M0. He received adjuvant chemotherapy over several years due to the high tumor stage. He claimed to have no recent body weight loss, nausea, melena, bowel habit changes, or tenesmus. Physical examination revealed mild left costovertebral angle knocking pain. Results of complete blood count and urinalysis were normal. The level of carcinoembryonic antigen (CEA, 2.12 ng/mL) was within normal limits. Computed tomography of the abdomen A 66-year-old man, with a history of gastric signet ring cell carcinoma, was admitted due to intermittent dull pain in the left lower abdomen for 3 months. Left ureteral obstruction with suspicious tumor encasement and hydronephrosis was found on imaging studies. Endoscopic ureteral biopsy revealed infiltrating high-grade urothelial carcinoma. As a result, he underwent left nephroureterectomy and bladder cuff excision. Unexpectedly, metastatic carcinoma of the left ureter from the stomach was the final diagnosis after comparison of the permanent sections of the two specimens. Unfortunately, acute disseminated intravascular coagulation developed and the patient died of disease complications 16 days after the operation, even with intensive care. The details of this rare condition are reported herein with a review of the medical literature.
doi:10.1016/s1607-551x(08)70159-1 pmid:18635418 fatcat:tzqsvm7prbgrjivknb2thbetpu