title: Mesenteric ischemia after capecitabine treatment in rectal cancer and resultant short bowel syndrome is not an absolute contraindication for radical oncological treatment.
abstract: BACKGROUND
  Thrombotic events, arterial or venous in origin, still remain a source of substantial morbidity and mortality in cancer patients. The propensity for their development in oncology patients is partially a consequence of the disease itself and partially a result of our attempts to treat it. One of the rarest and deadliest thromboembolic complications is arterial mesenteric ischemia. The high mortality rate is caused by its rarity and by its non-specific clinical presentation, both of which make early diagnosis and treatment difficult. Hence, most diagnoses and treatments occur late in the course of the disease. The issue survivors of arterial mesenteric ischemia may face is short bowel syndrome, which has become a chronic condition after the introduction of parenteral nutrition at home.
  
  
  METHODS
  We present a 73-year-old rectal cancer patient who developed acute arterial mesenteric thrombosis at the beginning of the pre-operative radiochemotherapy. Almost the entire length of his small intestine, except for the proximal 50 cm of it, and the ascending colon had to be resected. After multiorgan failure his condition improved, and he was able to successfully complete radical treatment (preoperative radiotherapy and surgery) for the rectal carcinoma, despite developing short bowel syndrome (SBS) and being dependent upon home-based parenteral nutrition to fully cover his nutritional needs.
  
  
  CONCLUSIONS
  Mesenteric ischemia and resultant short bowel syndrome are not absolute contraindications for radical oncological treatment since such patients can still achieve long-term remission.
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Ana
authors.initials: A
authors.lastname: Perpar
authors.affiliation: Department of Oncological Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Erik
authors.initials: E
authors.lastname: Brecelj
authors.affiliation: Clinical Nutrition Unit, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Nada Rotovnik
authors.initials: NR
authors.lastname: Kozjek
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Franc
authors.initials: F
authors.lastname: Anderluh
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Irena
authors.initials: I
authors.lastname: Oblak
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Marija Skoblar
authors.initials: MS
authors.lastname: Vidmar
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Vaneja
authors.initials: V
authors.lastname: Velenik
keywords: acute mesenteric ischemia; capecitabine; multiorgan failure; rectal cancer; short bowel syndrome