A Case of Intestinal Perforation during Bevacizumab Combination Chemotherapy for Inoperable Advanced Breast Cancer

Abstract

A 54-year-old woman was diagnosed with inoperable breast cancer (T2 N1 M1 (PER, PLE), Stage IV) and received chemotherapy with paclitaxel (PTX). She showed primary tumor reduction and disappearance of her pleural effusion, but her ascites remained unchanged. On laparoscopic examination, the entire peritoneum was thickened, and the small intestine, colon, and omentum coalesced to form an omental cake. Part of the peritoneum was submitted for pathological examination, and it showed peritoneal dissemination of breast cancer. Based on these results, PTX and bevacizumab (BV) combination chemotherapy was started, and the ascites decreased. However, gastrointestinal perforation occurred on the 26th day of the 2nd course of PTX + BV, and emergency surgery was performed. During the operation, the omental cake was removed, and it was possible to examine the full length of the gastrointestinal tract. Two small perforations of the small intestine were recognized 120 cm from the ligament of Treitz. Simple closures of the perforations and peritoneal lavage drainage were performed. Although the patient had septic shock, she improved. It was thought that the small intestinal perforations had occurred because the addition of BV was very effective as chemotherapy. Gastrointestinal perforation caused by BV given for breast cancer is very rare and has not been reported so far in Japan. This very rare and valuable case was reported along with a discussion based on the literature.