A case report of perforation of the small bowel in a patient with recurrence of rectal cancer during treatment with bevacizumab after pelvic irradiation

Abstract

A 70-year-old male patient with rectal cancer underwent Miles' operation in April 2005. In June 2006, a computed tomography (CT) scan revealed local recurrence in the presacral region and lung metastases. In July 2006, the patient received pelvic irradiation at a total dose of 50 Gy. He also received modified FOLFOX6 chemotherapy. After a total of 28 courses, a CT scan showed that local recurrence is a stable disease (SD) while yet lung metastases being a progressive disease (PD). In April 2008, therefore, he received FOLFIRI2 instead of modified FOLFOX6 in combination with bevacizumab. There was no change (NC) during a total of 19 courses. In Mach 2009, 5 days after the last dose, the patient suddenly developed abdominal pain and a fever and visited the outpatient department. A CT scan showed gastrointestinal tract perforation. The patient was diagnosed with peritonitis and underwent emergency surgery. Since an ileal perforation was observed, the small bowel was partially resected. Drainage was performed and an artificial anus was made in the ileum. Gastrointestinal tract perforation is one of the most serious adverse events associated with bevacizumab. Risk following irradiation is known to be high and it is considered that utmost care is required at treatment.