• Marco Cascella, Marco Mc Cascella, Manuela Arcamone, Manuela Ma Arcamone, Emanuela Morelli, Emanuela Em Morelli, Daniela Viscardi, Daniela Dv Viscardi, Viera Russo, Viera Vr Russo, Silvia De Franciscis, Silvia Sdf De Franciscis, Andrea Belli, Andrea Ab Belli, Rosanna Accardo, Rosanna Ra Accardo, Domenico Caliendo, Domenico Dc Caliendo, Elena De Luca, Elena Edl De Luca, Barbara Di Caprio, Barbara Bdc Di Caprio, Francesco Di Sauro, Francesco Fds Di Sauro, Giovanni Giannoni, Giovanni Gg Giannoni, Carmine Iermano, Carmine Ci Iermano, Maria Maciariello, Maria Mm Maciariello, Marcella Marracino, Marcella Mm Marracino, Arturo Cuomo, and Arturo Ac Cuomo.
• Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCSS, Naples, Italy. m.cascella@istitutotumori.na.it.
• J Med Case Rep. 2015 Jan 1;9:175.

IntroductionHyperhomocysteinemia is a known risk factor for myocardial infarction, stroke, peripheral vascular disease, and thrombosis. Elevated plasma homocysteine levels have been demonstrated in patients with recurrent episodes or a single episode of thrombosis. Here we describe the development of cardiovascular disease as a complication of a surgical intervention in a patient with colorectal cancer and hyperhomocysteinemia.Case PresentationA 65-year-old Caucasian man complained of pain and constipation, attributed to previously diagnosed adenocarcinoma (stage IIB) of the hepatic flexure. An anamnestic investigation showed that he had undergone two surgical interventions. During both, he suffered thrombotic postoperative complications, a deep vein thrombosis of the upper extremity after the first operation and retinal vein occlusion after the second. He was diagnosed with hyperhomocysteinemia associated with a homozygous C677T mutation of the gene encoding the enzyme methylenetetrahydrofolate reductase. Our patient was initially treated with folic acid and high-dose B vitamins. On day 7 he underwent a right hemicolectomy. Anesthesia was performed with sevoflurane in 40% O2 and without the use of nitrous oxide. Postoperatively, our patient remained on folic acid and B vitamins and was without immediate or subsequent complications.ConclusionsNeoplastic disease and related surgery followed by the administration of chemotherapeutic drugs alter the hemostatic balance in cancer patients. Those suspected of also having a thrombophilic disease require a thorough laboratory diagnostic workup, including a molecular analysis aimed at identifying the genetic mutation responsible for the hyperhomocysteinemia, as indicated. The case described in this report highlights the importance of a multidisciplinary approach that includes expertise in peri-operative anesthesia, surgery, oncology, and hematology.

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