A case of colonic diverticulitis occurring after chemotherapy for small cell carcinoma of the lung

Abstract

A 65-year-old man was diagnosed as having small cell carcinoma of the lung ; he had cancer pain and was treated with anticancer drugs and oxycodone. The patient developed abdominal pain 17 days after the final anticancer drug treatment. His temperature was 39.7°C ; he had tenderness and muscular guarding in the right lower abdomen. His white blood cell count was 3,000/μl, and the serum CRP level was 1.53 mg/dl. Abdominal computed tomography (CT) showed colonic diverticulitis ; conservative therapy with antibiotics was started. Although the muscular guarding improved, tenderness and inflammatory change continued. Abdominal CT on the 5th hospital day showed a pericecal abscess. A laparotomy revealed a pericecal abscess due to perforation of colonic diverticulitis ; an ileocecal resection was performed. The patient was transferred to the department of respiratory medicine on the 26th postoperative day. Although the patient was treated with chemotherapy, he died 7 months after surgery. Conservative therapy for colonic diverticulitis is sometimes ineffective in patients undergoing chemotherapy for malignancies even if bone marrow suppression is not evident. Therefore, surgery should be considered based on a careful evaluation of the clinical and laboratory findings.