Abstract
[Case] The case involved a 58-year-old man. [Present histories] The patient, who had been on bavacizumab combination chemotherapy for advanced sigmoid colon cancer and multiple hepatic metastases, developed stenosis at the colon proximal to the sigmoid colon cancer. He presented with ileus symptoms, and then a colonic stent was placed 13 days after the final day of the chemotherapy. The patient complained of lower abdominal pain and was transferred to our hospital because the pain persisted. [Clinical course] Abdominal CT scan revealed intraabdominal free air, small quantities of ascites, and thickening of the intestinal wall at where the stent was placed. Colonic perforation due to the colonic stent was thus diagnosed and an emergency laparotomy was performed on the same day. [Operative findings] Large quantities of stool juice were identified in the abdominal cavity, and the perforated portion was present in the colon proximal to the colonic stent. We employed a Hartmann operation by performing the associated resection of the colonic stent and the intestine including the narrowing portion. [Considerations] Recently the usefulness of the stent placement has been increasingly reported for a narrowing portion of the colon caused by a malignant neoplasm which is unresectable. However, such stent placement in the colon might entail an increasing risk of perforation when it is used during bevacizumab combination chemotherapy. Careful attitude would be mandatory for the use in such cases.
