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 ga stric cancer, and an expanding right common iliac artery aneurysm were evid ent. The patient underwent an artificial graft implantation, partial gastre ctomy, and transverse colectomy, simultaneously. To protect against graft i nfection, the aneurysm was resected first, and then the retroperitoneum was tightly closed to isolate the graft from the peritoneal cavity. The postop erative course was uneventful, except for symptoms of temporary delirium. R ecently, simultaneous surgery for concomitant abdominal aortic aneurysms an d early gastric cancer has been commonly performed in Japan because the con tamination of the peritoneal cavity during a gastrectomy is thought to be l ess severe than that during lower abdominal surgery. However, the positive rate for bacterial culture in colorectal resections is virtually the same a s that in gastrectomies. Moreover, the incidence of graft infection is subs tantially 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 al ways result in graft infection. The present case illustrates the benefits o f a simultaneous operation for both an aneurysm and gastrointestinal malign ancy.