Abstract
A 73-year-old woman underwent sigmoidectomy for sigmoid colon cancer with simultaneous multiple hepatic and pulmonary metastases, followed by six courses of chemotherapy with FOLFOX4 and additional 16 courses of the FOLFOX4 therapy combined with bevacizumab. On the way to the termination of the therapy, at the ninth course, Grade 2 allergic reaction for oxaliplatin developed. Thereafter oxaliplatin alone was withdrawn from the therapy. Since her disease progressed, the therapy was changed for bevacizumab + FOLFORI. When 10 days had elapsed after administration of bevacizumab, the patient complained of right lower abdominal pain and was admitted to our hospital with a diagnosis of acute appendicitis. Conservative therapy was ineffective, so that emergency operation was performed. Upon laparotomy no peritoneal dissemination was present and necrotic appendicitis covered with the greater omentum was noted. Appendectomy was performed and the surgical stump was inverted into the cecum. The patient required management with artificial respiration for 14 postoperative days and was associated with various complications such as subcutaneous abscess, abdominal wall abscess, and dermatorrhea of intestinal juice. We were able to resume the FOLFIRI therapy on the 55th postoperative day. Particular attention must be paid to the postoperative course in patients who have undergone emergency operation during administration of bevacizumab.
