A rare cause of small bowel obstruction which should always be considered

consisted of chemoradiation therapy in the following manner: Two cycles of Paclitaxel (Taxol®)-Carboplatin followed by Paclitaxel-Carboplatin with radiation therapy (XRT) to the GE junction for six weeks followed by maintenance Folinic Acid-Oxaliplatin-Fluorouracil (FOLFOX 6) every two weeks. Drug dosing was modified in accordance with complete blood count (CBC) results. Serial PET scans were performed to assess efficacy, showing a range of complete absence of abnormal F-FDG uptake to occasional uptakes in various locations with mild to moderately elevated maximal SUV units. At present, the patient is alive with a good QOL approximately 3.5 years from LVAD implantation and 3 years from esophageal cancer diagnosis. Results and Conclusions: Multi-disciplinary therapies were instituted to treat two lethal conditions: end-stage heart failure and advanced esophageal cancer. The combination of medical therapy with chemotherapy, interventional therapy with radiation, and surgical therapy with an LVAD proved efficacious in this otherwise fatal case. As more patients with end-stage heart failure are implanted with LVADs particularly for DT the likelihood of non-cardiac conditions will undoubtedly appear cancer among them. The challenge will be to determine how to best approach these conditions. This case illustrates the power of a collaborative approach in the management of this complex problem. Take home message: The use of the implantable LVAD has enabled patients with end-stage heart failure to live longer and with an improved QOL. As a result of not dying from heart failure, some patients will experience serious non-cardiac conditions including cancer. With the growing number of DT-LVAD patients worldwide, it will be imperative for healthcare providers to address the treatment of these maladies utilizing a multi-specialty approach.