Huang Wen Tsung, Chang Kung Chao, Shan Yan Shen, Tsao Chao Jung, Lee Jenq Chang
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1436-9.
Cancer-associated acute disseminated intravascular coagulation is rare in colorectal cancer, but is rapidly fatal when present. We present a case of a 79-year-old male who developed acute disseminated intravascular coagulation one month after receiving Hartmann's procedure for his rectal cancer. Peripheral blood showed leucoerythroblastosis while marrow carcinomatosis was noted by bone marrow examination. Prompt chemotherapy with weekly 24-h infusion of 5-fluorouracil and leucovorin were administered and the acute disseminated intravascular coagulation gradually resolved after 2 cycles of treatment. A total of 10 cycles of weekly chemotherapy were administered. The patient died of pneumonia on the 83rd day after diagnosis of disseminated intravascular coagulation without evidence of acute disseminated intravascular coagulation and tumor progression. We suggest that if acute disseminated intravascular coagulation developed after surgery for rectal cancer, the cancer-related acute disseminated intravascular coagulation should be taken into consideration. The immediate administration of chemotherapy may save the patient in time.
癌症相关的急性弥散性血管内凝血在结直肠癌中很少见，但一旦出现则会迅速致命。我们报告一例79岁男性患者，其在接受直肠癌Hartmann手术一个月后发生急性弥散性血管内凝血。外周血显示有幼粒-幼红细胞血象，骨髓检查发现骨髓转移癌。给予每周24小时输注5-氟尿嘧啶和亚叶酸钙的快速化疗，2个周期治疗后急性弥散性血管内凝血逐渐缓解。共进行了10个周期的每周化疗。患者在诊断为弥散性血管内凝血后的第83天死于肺炎，此时无急性弥散性血管内凝血及肿瘤进展的证据。我们建议，如果直肠癌手术后发生急性弥散性血管内凝血，应考虑癌症相关的急性弥散性血管内凝血。立即给予化疗可能及时挽救患者生命。
