A Case of Duodenal Perforation in a Patient with Nonresectable Ascending Colon Cancer During Treatment with Bevacizumab＋XELOX

Abstract

The patient was a 54-year-old man diagnosed with nonresectable ascending colon cancer and multiple liver metastases in August 2010, so we started treating him with chemotherapy on bevacizumab+XELOX. After the third chemotherapy cycle, he developed acute epigastric pain and tenderness with muscular guarding. A computed tomography scan showed a significant amount of free air in the abdomen, and fluid accumulation around the hepatoduodenal ligament. Under the diagnosis of generalized peritonitis due to a digestive tract perforation, an emergency operation was performed. Intraoperatively, contaminated ascites had accumulated, and a 2 mm in diameter orifice was found in the anterior duodenal bulb. We performed a peritoneal lavage, closure of the perforated lesions in the duodenum, and an omental implantation repair. When a patient undergoing chemotherapy with bevacizumab develops acute abdominal pain, attention should be paid to a major complication such as a digestive tract perforation.