Embolic mesenteric infarction: a unique initial manifestation of renal cell carcinoma

Renal cell carcinoma is an unpredictable tumor that often has already metastasized when first seen. It can affect many organs before the primary tumor is found. We describe a unique example of renal cell carcinoma first seen as repeated episodes of small-bowel infarction caused by tumor emboli from a metastasis in the left ventricle. Although intestinal ischemia caused by emboli is not uncommon, intestinal ischemia resulting from metastatic tumor emboli occurs in only a small percentage of cases. We suggest that surgeons include the possibility of tumor emboli in the differential diagnosis for mesenteric or peripheral ischemia that cannot be attributed to more common causes.