Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Chinaemerem Chukwudoro, OMS III 1 ; Mohamed-Aly Bakeer, MD 2 1 VCOM-Louisiana; 2 St Francis Medical Center, Monroe Louisiana 64 HYPERCOAGULABILITY AND THROMBOTIC COMPLICATIONS IN ADVANCED COLON CANCER: A CASE OF IRON DEFICIENCY ANEMIA, BILATERAL DEEP VEIN THROMBOSIS, AND PULMONARY EMBOLISM

Cameron Cluney, OMS-II; Allen Dennis, OMS-II; Anthony Giuffrida, MD 1 VCOM-Louisiana; 2 Cantor Spine Center 65 A CASE STUDY OF SPONTANEOUS RESORPTION OF DISC PROTRUSION WITH NON-SURGICAL INTERVENTIONS

Context/Impact: Colorectal cancer is the third most common malignancy worldwide and a leading cause of cancer-related deaths, with an increasing burden due to aging populations and lifestyle factors. A significant yet under-recognized complication of advanced malignancy is hypercoagulability, which predisposes patients to venous thromboembolism (VTE). This case highlights the essential need for thorough evaluation in patients with overlapping risk factors to enable timely intervention and improve outcomes. adenocarcinoma of the transverse colon, presenting uniquely with severe anemia and thromboembolic complications. Imaging revealed a friable, near-obstructing mass in the transverse colon, explaining the patient’s chronic blood loss and severe anemia. During the diagnostic workup, bilateral deep vein thromboses (DVTs) and pulmonary embolism (PE) were identified. While these thrombotic events were likely driven by malignancy-induced hypercoagulability, the patient’s occupation as a truck driver, involving prolonged periods Report of Case: This report examines a 60-year-old male with Stage IIIc

of immobility, may have been a contributing factor. A multidisciplinary treatment plan was initiated, including surgical resection of the transverse colon, anticoagulation therapy, placement of an inferior vena cava (IVC) filter, and adjuvant chemotherapy using 5-fluorouracil and oxaliplatin. The patient’s course demonstrated successful resolution of acute symptoms and effective management of complications, with secondary prevention measures also implemented. Furthermore, the case underscores the importance of detailed symptom assessment and the integration of systemic therapy to mitigate the prothrombotic risks associated with malignancy. Comments/Conclusions: This case illustrates the complex relationship between cancer-associated hypercoagulability and thrombotic complications. A literature review was conducted using PubMed and UpToDate, with search terms like colon cancer hypercoagulability, cancer-associated thrombosis, and iron deficiency anemia and malignancy. The hypercoagulability in this patient aligns with patterns seen in advanced cancers, which increase the risk of venous

thromboembolism (VTE). The combination of surgery and systemic chemotherapy follows current oncology guidelines. This case also emphasizes the need for patient education on recognizing thromboembolism symptoms and the importance of follow-up care to optimize outcomes. Overall, it highlights the value of a multidisciplinary approach and patient education in managing complications and improving outcomes in cancer-associated hypercoagulable states.

Context: This case highlights the spontaneous resorption of a lumbar disc protrusion following conservative management and non-surgical interventions, offering a valuable example of successful symptomatic relief without the need for surgical intervention. It reinforces evidence supporting conservative care as a primary approach for managing symptomatic lumbar disc herniations, especially in cases involving persistent radicular symptoms. A 37-year old female with a longstanding history of low back pain presented with persistent axial pain radiating along an L4 distribution. Symptoms included exacerbation when lying flat, prolonged sitting, or driving. Conservative treatments provided limited relief, with temporary improvement following oral steroids. MRI findings identified an L4/L5 disc protrusion as the primary pain generator, leading to axial pain and right-sided radicular symptoms. Over four months, treatment included interlaminar, bilateral transforaminal, and intradiscal steroid injections at L4/L5, each offering temporary relief lasting 3-4 weeks. After three months of symptom persistence, surgical evaluation suggested a possible discectomy, though the patient delayed follow-up. Approximately seven months after

initial presentation, radicular symptoms had resolved significantly, correlating with MRI findings of spontaneous disc reabsorption. Despite this improvement, the patient reported new low-level axial back pain. Ongoing management focuses on conservative treatment for both axial lumbar pain and concurrent cervical pathologies. This case illustrates the potential for spontaneous disc reabsorption to alleviate radicular symptoms and underscores the challenges in managing persistent axial low back pain. In this case, symptomatic relief and large disc protrusion reabsorption were achieved after 8 months following a cohort of conservative care and non-surgical interventions. It cannot be determined which interventions directly contributed to the outcome of this patient, however we do know that they were achieved through some combination of those conducted. This case adds to previous cases and research showing that conservative care coupled with non-surgical interventions such as epidural steroid injections should be the first line treatment for disc herniations before resulting in discectomy or other surgical options.

References: Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2023 Jan 16]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www. ncbi.nlm.nih.gov/books/NBK441822/Wilby, M. J., Best, A., Wood, E., Burnside, G., Bedson, E., Short, H., Wheatley, D., Hill-McManus, D., Sharma, M., Clark, S., Baranidharan, G., Price, C., Mannion, R., Hutchinson, P. J., Hughes, D. A., Marson, A., & Williamson, P. R. (2021). Surgical microdiscectomy versus transforaminal epidural steroid injection in patients with sciatica secondary to herniated lumbar disc (NERVES): a phase 3, multicentre, open-label, randomised controlled trial and economic evaluation. The Lancet. Rheumatology, 3(5), e347–e356. https:// doi.org/10.1016/S2665-9913(21)00036-9Yu, P., Mao, F., Chen, J., Ma, X., Dai, Y., Liu, G., Dai, F., & Liu, J. (2022). Characteristics and mechanisms of resorption in lumbar disc herniation. Characteristics and mechanisms of resorption in lumbar disc herniation - PMC (nih.gov)

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2025 Research Recognition Day