2022 Volume 42 Issue 5 Pages 577-580
The patient was a 79-year-old woman who had undergone laparoscopic ileocecal resection and was receiving capecitabine ＋ oxaliplatin ＋ bevacizumab therapy for appendiceal cancer (pT4bN3M1c1 StageⅣc). On the second day after completion of the fifth course of chemotherapy, the patient was transported to our hospital with abdominal pain. Abdominal contrast-enhanced computed tomography (CT) revealed strangulated bowel obstruction, and emergency laparotomy was performed. Intraoperatively, as the strangulated bowel segment was found to show no evidence of necrosis, resection was not performed. The patient developed severe abdominal pain of sudden onset on the 6th day; while an immediate CT revealed only enlargement of the small intestine, emergency operation was performed on the following day because CT revealed ascites and free air. Since perforation of the strangulated segment of the small intestine was present, partial resection of the small intestine was performed, with functional end-to-end anastomosis. The postoperative course was good, and the patient was discharged on the 21st day. Although the side effect of delayed healing, which entails the risk of anastomotic leakage, is known with bevacizumab, intestinal resection and primary anastomosis should be considered if the intestinal diameter decreases irreversibly after the release of strangulated bowel obstruction.
