Abstract
A 54-year-old man, who complained of chest discomfort and was scheduled to undergo surgery with a diagnosis of cancer of the pancreas tail at another hospital, was seen at the hospital for his own request. We recommended surgery with the same diagnosis but he refused it. One month later the patient was seen at the hospital again because of the onset of abdominal pain and desired to receive surgery. His surgery resulted in exploratory laparotomy because he had hepatic metastasis and peritoneal dissemination as well. After discharge, one course of chemotherapy with gemcitabin hydrochloride was completed on an ambulant basis when he developed upper abdominal pain with chill and shiver. An abdominal CT scan showed that most of the tumor became necrotic to form a cavity. Intra-abdominal free air was also noted. It was etiologically considered that a portion of the transverse colon involved in the tumor had come to tumor necrosis resulting from the efficacy of chemotherapy, and then had perforated. In the clinical course, he developed gastrointestinal bleeding and required transverse colectomy and colostomy.
Colorectal perforation developed during chemotherapy with single use of gemcitabin hydrochloride is so rare that only two cases, including our case, have been reported in Japan. Bibliographical comments are also presented here.
