Double Perforation after Colorectal Cancer Surgery During Bevacizumab Treatment

Lucian Sorin Andrei,Ioana Dinu,Radu Sorin Popisteanu,Alexandru Micu,Adriana Andrei

doi:10.31689/rmm.2020.27.4.309

Lucian Sorin Andrei, Ioana Dinu + Show 3 more

Open Access

https://doi.org/10.31689/rmm.2020.27.4.309

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Abstract

Bevacizumab is a monoclonal antibody which has shown promising results in the treatment of varied malignant pathology, including metastasized colorectal cancer. It acts by inhibiting VEGF (vascular endothelial growth factor), and one of its most cited complications is intestinal perforation, by mechanisms which are not yet fully understood. We present the case of a 68 year old patient, operated for metastasized colorectal cancer, which underwent chemotherapy with Bevacizumab, and shortly after initiating therapy developed fi stula of low colorectal anastomosis, followed by ischemic perforation of the small intestine.

Highlights

Bevacizumab (Avastin) is used in the treatment of metastasized colorectal cancers
One of them implies the lesion of the intestinal mucosa by altering its protection factors, such as prostacyclin and nitric oxide, that are both dependent on VEGF
By inhibiting VEGF, bevacizumab inhibits the function of some coagulation factors, resulting in thrombosis and obstruction of the splanchnic vascularization, which in turn leads to ischemia and perforation of the intestines[9,1]

Summary

INTRODUCTION

Bevacizumab (Avastin) is used in the treatment of metastasized colorectal cancers. The incidence of intestinal perforations cited by clinical studies was of about 2%6,7. We present the case of a 68 year old patient, with history of resected prostate cancer followed by hormone. CT scan shows anorectal collection, secondary to fistula of low coloanal anastomosis (Figure 1). The patient underwent surgery for intestinal obstruction by stenosis and fistula of low coloanal anastomosis, peritoneal adhesions, for which a loop colostomy and adhesion dissection is performed. The patient develops bronchopneumonia, which under specific conservative treatment is remitted. Intraoperative diagnosis is peritonitis through segmental small bowel necrosis with ischemic perforation. The histological examination of the resected intestine showed area of total necrosis, with acute inflammatory cell infiltration, and hemorrhagic areas through the entire intestinal wall (Figure 2)

DISCUSSION

CONCLUSIONS