Impact of Primary Tumor Resection on Type B Lactic Acidosis in a Case of Metastatic Colon Cancer

Abstract

Malignancies seldom lead to hyperlactatemia or lactic acidosis. The elimination of the primary tumor is anticipated to result in the amelioration of lactate levels in such situations. A patient with obstructing descending colon cancer was subjected to surgical intervention as their serum lactate levels reached 3.6 mmol/L. The tumor was removed, and the ischemic bowel proximal to it was excised as well. The patient demonstrated signs of recuperation; however, their serum lactate levels persisted at levels exceeding 6.5 mmol/L. Consequently, the patient was subjected to further investigation and surgical intervention. A CT scan of the brain and abdomen indicated metastases to the liver and brain, respectively. The presence of metastases in colonic malignancies may impede the normalization of hyperlactatemia even after excising the primary tumor. The interpretation of lactate levels can be challenging and radiological assessments, including abdominal reexploration, may be required to ascertain the diagnosis.

Keywords: colon cancer; hyperlactatemia; lactic acidosis; metastasis; warburg effect.

Figure 1. Resected specimen following left hemicolectomy showing gangrenous transverse colon with few perforations (A) and a rectosigmoid growth (B)

Figure 2. Contrast-enhanced CT (CECT) scan of the abdomen showing liver metastasis

Figure 3. Non-contrast-enhanced CT (CECT) scan of the brain showing brain metastasis