A case of strangulation ileus occurring during bevacizumab treatment requiring resection and primary anastomosis of the intestinal tract resulting in no further complications

Abstract

The patient was a 59-year-old male who received bevacizumab + mFOLFOX6 therapy for synchronous multiple liver metastases after resection of multiple rectal carcinoma lesions. In the 12^th month after the commencement of treatment, the patient was judged to have progressive disease. Thus, the treatment was changed to bevacizumab + FOLFIRI therapy. On the 5^th day after the second administration of bevacizumab + FOLFIRI (bevacizumab : 14 total treatments), the patient developed abdominal pain and vomiting. The patient was diagnosed as having a strangulated ileus based on the results of plain X-rays of the abdomen and abdominal CT. Therefore, an emergency operation was performed that day. Intraoperative findings included necrosis in a 30-cm part of the small intestine beginning from approximately 5 cm from the ligament of Treitz. The necrotic intestine was removed, and a side-to-side anastomosis was performed. There were no postoperative complications ; FOLFIRI therapy was commenced again on postoperative day 48. Starting on postoperative day 73, the concomitant administration of bevacizumab was allowed for a total of 7 times. The patient died 23 months after starting the initial treatment. Complications caused by the delayed healing of a wound can be avoided by selecting an appropriate anastomotic method for the intestinal tract, even during emergency surgery performed subsequent to bevacizumab administration.