Abstract
A 79-year-old woman who had undergone right hemicolectomy, partial hepatectomy, cholecystectomy, and lymph node dissection for transverse colon cancer accompanied by liver infiltration exhibited elevated CEA levels 3 months after surgery. Postoperative local recurrence was observed, and Bevacizumab+XELOX therapy was started. After completing two courses, she sought an outpatient consultation with a chief complaint of abdominal pain. Generalized peritonitis due to gastrointestinal tract perforation was diagnosed and she underwent emergency surgery. A perforated area was observed in the anterior wall of the gastric antrum, and irrigation drainage of the open abdomen and mesh covering were performed. After surgery, intense abdominal pain and fever were again noted on hospital day 23, and CT showed intraperitoneal free gas and ascites. Gastrointestinal tract reperforation was diagnosed, and she again underwent emergency surgery. A search for the perforated area failed to produce any clear evidence of perforation, so the surgery was concluded with irrigation drainage of the open abdomen and placement of a drain. After surgery, contrast from the drain tube showed access to inside the stomach, and a long time 90 days was required for fistula closure. Gastrointestinal tract perforation is known as a serious side effect of bevacizumab, but this is the first report of gastric perforation in Japan. We report herein our experience with a case in which peritonitis symptoms were recurrent and fistula closure took a long time.
