Unexpected outcome from Trousseau syndrome

We present the first reported case of early gastric carcinoma presenting with these paraneoplastic phenomena in an otherwise healthy farmer. The early presentation allowed for a curative partial gastrectomy, which itself was complicated by the presence of a deep vein thrombosis extending into the inferior vena cava. Fortunately, stabilization of the clot allowed for surgery to proceed without the need for a caval filter. The patient was referred for adjuvant chemotherapy and has since made an excellent recovery.This case provides new evidence for the presentation of superficial thrombophlebitis in early gastric carcinoma and the potential for curative surgery in such instances. A high index of suspicion and a prompt diagnostic workup are essential for timely planning and execution of surgery in these early albeit rare presentations.Unlike the well-established association of spontaneous venous thromboembolism (VTE) with occult neoplasia, single episodes of unprovoked superficial thrombophlebitis have been suggested not to be associated with malignancy [1]. In contrast, the historically significant Trousseau syndrome (i.e. migratory thrombophlebitis) is a well-described association of advanced malignancy - particularly of pancreatic and pulmonary tumours [2]. The mechanism of this paraneoplastic phenomenon is unknown but has been linked to the late stage of these tumours at presentation, which in all reported cases to date, has precluded any form of curative intervention in these patients [3,4].A 41-year-old farmer with no significant past medical history presented to Casualty with acute, severe pain over the medial aspect of his right leg and thigh. Examination revealed exquisitely tender cord-like thickening along the distribution of the long saphenous vein. The patient firmly denied external trauma but an infective cause of the inflammation was presumed 'until proven otherwise'.Intravenous penicillin and flucloxacillin were administered but the inflammation persist