Recurrent Deep Vein Thrombosis Shrouding a Sinister Colorectal Carcinoma in a Young Adult

Dear Editor, Venous Thromboembolism (VTE) is an essential concern for cancer patient, as they have a notably higher risk than non cancer patients, which can result in significant morbidity and mortality. Approximately 15% of cancer patients suffer from VTE, with risk persisting throughout the illness [1]. Colorectal cancer, with genetics as a primary risk determinant, exhibits a pronounced association with VTE. However, comprehensive guidelines for managing VTE in colorectal cancer patients remain elusive due to limited research. A 38-year-old tailor presented to the Outpatient Department (OPD) with complaints of left upper limb pain persisting for seven days. It significantly impaired his daily activities. His medical history revealed a recent diagnosis of Deep Vein Thrombosis (DVT) in the right leg, for which he was currently on warfarin therapy with no notable history of travel, trauma, or surgeries. Clinical examination indicated tachycardia and tachypnea; laboratory investigations indicated elevated D-dimer levels of 1240 ng/dL (normal: less than 300 ng/dL). Subsequent imaging studies, including colour Doppler imaging and pulmonary angiography, confirmed extensive DVT involving the left subclavian and ulnar veins, along with bilateral pulmonary emboli. Concurrently, the patient experienced distressing symptoms related to defecation and occasional rectal bleeding. With the suspicion of malignancy, explaining multiple episodes of venous thrombosis, a colonoscopy was done, revealing a friable mass in the rectum. On gross examination, it was reported as single, significant, ulcero-infiltrative and circumferential growth. Histopathology analysis suggested an ill-differentiated adenocarcinoma of the rectum [Table/Fig-1]. Contrast-enhanced Computed Tomography (CECT) unveiled widespread metastatic disease involving the colon and para-aortic lymph nodes [Table/Fig-2]. Consequently, the patient was referred to the Department of Surgical Oncology for palliative management, ultimately undergoing colonic bypass surgery.