A 67yearold man visited our hospital with a history of continuous hematochezia leading to hemorrhagic shock. An abdominal computed tomography scan re vealed a large mass in the ascending colon invading the duodenum and pancreatic head as well as extra vasation of blood from the gastroduodenal artery (GDA) into the colon. Colonoscopy revealed an irregular ulce rative lesion and stenosis in the ascending colon. There fore, right hemicolectomy combined with pyloruspreser ving pancreaticoduodenectomy was performed. Histolo gically, the tumor was classified as a moderately differentiated adenocarcinoma. Moreover, cancer cells were main ly located in the colon but had also invaded the duode num and pancreas and involved the GDA. Immunohisto chemically, the tumor cells were positive for cytokeratin (CK)20 and carcinoembryonic antigen (CEA) but not for CK7 and carbohydrate antigen (CA)199. The patient died 23 d after the surgery because he had another episode of arterial bleeding from the anastomosis site. Al though En bloc resection of the tumor with pancreatico duodenectomy and colectomy performed for locally ad vanced colon cancer can ensure longterm survival, patients undergoing these procedures should be carefully monitored, particularly when the tumor involves the main artery.
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