Successful simultaneous operation of concomitant early gastric cancer, transverse colon cancer, and a common iliac artery aneurysm.
In an 83-year-old Japanese man, concomitant bleeding colon cancer, early gastric cancer, and an expanding right common iliac artery aneurysm were evident. The patient underwent an artificial graft implantation, partial gastrectomy, and transverse colectomy, simultaneously. To protect against graft infection, the aneurysm was resected first, and then the retroperitoneum was tightly closed to isolate the graft from the peritoneal cavity. The postoperative course was uneventful, except for symptoms of temporary delirium. Recently, simultaneous surgery for concomitant abdominal aortic aneurysms and early gastric cancer has been commonly performed in Japan because the contamination of the peritoneal cavity during a gastrectomy is thought to be less severe than that during lower abdominal surgery. However, the positive rate for bacterial culture in colorectal resections is virtually the same as that in gastrectomies. Moreover, the incidence of graft infection is substantially lower than the positive rate for bacterial culture in surgery for aneurysms. Some surgeons object to a simultaneous resection due to fear of graft infection, but even the presence of infectious organisms does not always result in graft infection. The present case illustrates the benefits of a simultaneous operation for both an aneurysm and gastrointestinal malignancy.