Cases Of Gastrointestinal Perforation Research Articles

A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon.

We encountered a case of a large hematoma developing with perforation shortly after a cold snare polypectomy for a colorectal adenoma. The patient underwent cold snare polypectomy for a 3-mm type Is lesion in the transverse colon at another facility. Two hours later, she visited the emergency room due to abdominal pain. Contrast-enhanced computed tomography revealed a 70 mm, high-intensity mass in the transverse colon with contrast extravasation. We attempted transcatheter arterial embolization to stop the bleeding. Several hours later, the anemia had not worsened, but the severe abdominal pain persisted. Urgent laparoscopic right hemicolectomy was performed due to the possibility of gastrointestinal perforation. The surgery was successfully completed. Pathology reports confirmed the presence of an intramural hematoma in the proximal transverse colon with hemorrhagic infiltration of all layers, along with extensive ischemic changes. A perforation was identified in this area, with mucosal defects observed near the hole, possibly due to cold snare polypectomy.

Open abdominal vacuum pack technique for the management of severe abdominal complications after cytoreductive surgery in ovarian cancer

IntroductionThe aim of this study was to evaluate the indications and management of grade III-IV postoperative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis. MethodsRetrospective study of prospectively collected data from patients who underwent a cytoreductive surgery by laparotomy for an epithelial ovarian cancer that required postoperative management of an open abdomen. An abdominal vacuum-assisted wound closure (VAWC) was applied in cases of abdominal compartmental syndrome (ACS) or intra-abdominal hypertension, to prevent ACS. The fascia was closed with a suture or a biologic mesh.The primary aim was to achieve primary fascial closure. Secondary outcomes considered included complications of cytoreductive surgery (CRS) and open abdominal wounds (hernia, fistula). ResultsTwo percent of patients who underwent CRS required VAWC during the study's patient inclusion period. VAWC indications included: (i) seven cases of gastro-intestinal perforation, (ii) three necrotic enterocolitis, (iii) two intestinal ischemia, (iv) three anastomotic leakages and (v) four intra-abdominal hemorrhages. VAWC was used to treat indications (i) to (iv) (which represented 73.7% of cases), to prevent compartmental syndrome. Primary fascia closure was achieved in 100% of cases, in four cases (21.0%) a biologic mesh was used.Median hospital stay was 65 days (range: 18–153). Four patients died during hospitalization, three of these within 30 days of VAWC completion. ConclusionVAWC for managing open abdominal wounds is a reliable technique to treat surgical post-CRS complications in advanced ovarian cancer and reduces the early post-operative mortality in cases presenting with severe complications.

Retroperitoneal duodenal perforation due to COVID-19: An extremely rare case report

Introduction and importanceGastrointestinal (GI) symptoms are the most common extrapulmonary presentation of coronavirus disease 2019 (COVID-19) infection. GI perforation may be an unusual manifestation of COVID-19 infection.Case presentationWe report a 45-year-old man who presented with acute abdominal pain without any respiratory symptoms to our emergency department. Investigations revealed retroperitoneal duodenal perforation and fibrotic changes in lung bases. Laboratory findings demonstrated a positive polymerase chain reaction (PCR) test for COVID-19 and mild leukocytosis.Clinical discussionCOVID-19 related perforation of the retroperitoneal part of the duodenum is extremely rare, and to the best of our knowledge, this is the first reported case. With increasing COVID-19 infection, we might see more cases of GI perforation. In the era of COVID-19 pandemic, any abdominal signs and symptoms should alert the clinicians to consider COVID-19 diagnosis in the differential.ConclusionConservative management with close monitoring, antibiotic therapy and serial examinations were completely successful. The patient's general condition improved, and he was discharged on day 7 of hospitalization.

Duodenal Perforation in a Patient with Dengue Fever –A Rare Entity

A 37-year-old gentleman presented to the emergency with a history of high-grade fever for 2 days and abdominal pain for one day. On arrival at the emergency department, he was hypotensive and tachycardic, while on abdominal examination he had generalized abdominal tenderness. He was started on fluid resuscitation with intravenous crystalloids. The initial impression was of an acute abdomen. The Abdominal X-ray showed air under the diaphragm. He was rushed to the operating room and underwent an emergency laparotomy that revealed a duodenal perforation for which he underwent Graham's patch repair and washout. No obvious cause was identified. He had low platelets for which Dengue NS-1 antigen was sent that came positive. Post-procedure he recovered and was discharged home. To our knowledge, this is the first case in which dengue fever associated with a duodenal perforation is being reported. It is the first case of gastrointestinal perforation in a patient with Dengue Fever to be reported outside of India. In endemic regions, clinicians must recognize such atypical manifestations.

Safety and efficacy of aflibercept in FOLFIRI regime in treatment of metastatic colorectal cancer in real clinical practice: results of Russian prospective multicentre observational study SAFETRAP

Aim. The main objective of the prospective multicentre observational study is to describe adverse events occurred during treatment with aflibercept plus FOLFIRI therapy in real life practice. In despite of broad use of aflibercept in Federal oncological centers, this regimen is still perceived by healthcare professionals (HCPs) as having worse safety profile in comparison with other antiangiogenic agents. Taking into account limited experience of using aflibercept in Russia it s critically important to evaluate and document adverse events occurred with treatment in aflibercept plus FOLFIRI regimen in patients with metastatic colorectal cancer (mCRC) in real-life practice. Methods. The physician selection was performed as a random process. Twenty sites with experience in treatment of mCRC patients were selected. The investigators were encouraged to enroll all patients meeting eligibility criteria in consecutive manner. Total number of included patients into the study patient was 101. Data were evaluable for 91 patients. 14 of 91 (15.4 %) patients didn ’t meet inclusion criteria and were excluded from the per protocol analysis: 10 patients didn ’t receive oxaliplatin within the last line of therapy preceding inclusion into the study and in 4 patients progression occurred more than 6 months after the end of adjuvant therapy. Results. Overall, 265 treatment emergent adverse events (TEAEs) occurred in the 77 patients analysed per protocol. In total, 23 grade 3 and 5 grade 4 TEAEs were reported by 16 and 4 patients, respectively. The most common TEAEs were nausea (68 events in 31 [40.3 %j patients), diarrhea (43 events in 25 [32.5 %j patients), hypertension (36 in 20 [26.0 %] patients), neutropenia (29 events in J5 [J9.5 %] patients), asthenia (28 events in 12 [15.6 %]patients). Three cases of grade 1-2 stomatitis were reported in 2 (2.6 %) patients. And one patient reported grade 1 epistaxis during the study. There was no case of gastrointestinal perforation, fistula development, ulceration, arterial or venous thromboembolism. During this study seven serious adverse events were documented in 5 (6.5 %) patients of 77. The reason for treatment discontinuation in 5 (11.1 %) of 45 cases was adverse event. No death, classified as related to any component of therapy, was reported in this study. Conclusion. This national (Russian) prospective multicentre non-interventional study conducted in patients with mCRC in daily practice suggests that aflibercept plus FOLFIRI has a manageable safety profile in line with VELOUR phase III study.

Laparotomy for duodenal obstruction, caused by a renal haematoma after extracorporeal shockwave lithotripsy

Extracorporeal shockwave lithotripsy is a widely used, acceptable and common first line treatment for non-conservatively managed renal and ureteric stone disease. Although considered a relatively safe non invasive treatment for renal and ureteric stones, can carry with it significant associated morbiditiy especially in high risk patients, such as those who are anticoagulated. Renal haematomas are not an uncommon finding after extracorporeal shockwave lithotripsy, however, fewer than 1% of patients presenting with a symptomatic renal haematoma require intervention in the form of urgent embolisation under interventional radiology, or emergency nephrectomy. Rare cases of splenic and hepatic haematomas have been reported and rarer still cases of gastro-intestinal perforation following extracorporeal shockwave lithotripsy. We report a case with a significant renal haematoma needing emergency embolisation of the renal artery, and subsequent development of duodenal obstruction from direct haematoma compression requiring a laparotomy and intended duodenal jejunal bypass. Level of evidence: 5

INCIDENCE AND AETIOLOGY OF GASTROINTESTINAL PERFORATION: A HOSPITAL BASED PROSPECTIVE STUDY.

Objectives: This study was to evaluate the incidence and various aetilogical factors in patients of gastrointestinal perforation.
 Methods: A detail history clinical examinations and relevant investigations were performed to all cases of gastrointestinal perforation. A total of 50 patients of gastrointestinal perforation with age group 0 to 80 years were enrolled. Patients were included on the presenting signs and symptoms like pain, vomiting, distension, alteration of bowel habits, fever, h/o loss of appetite and weight, dyspnoea and duration of illness. Clinical examination was followed by haematological, biochemical and radiological investigations were performed to all cases of gastrointestinal perforation.
 Results: Data was analysed by using SPSS version 26 software. All data was tabulated and percentages were calculated. One sample t test was applied. Mean and standard deviation were observed. P value was taken less than or equal to 0.05 for significant differences.
 Conclusions: Gastrointestinal perforation was commonly seen in younger age group. Ileum was the most common site for gastrointestinal perforation. Enteric fever and drugs were the most common aetiological factors of gastrointestinal perforation. Hence, awareness, early recognition of symptoms and referral of patients to hospital is very important for prevention and management of gastrointestinal perforation.
 Key words: gastrointestinal perforation, aetiological factors, age, sex

A case of gastrointestinal perforation caused by the ingestion of multiple magnets in a 1 year old boy

A case of gastrointestinal perforation caused by the ingestion of multiple magnets in a 1 year old boy

Anal Extrusion of Ventriculoperitoneal Shunt: A Report of Two Cases and Review of Literature.

We report two cases of gastrointestinal perforation by ventriculoperitoneal (VP) shunts and review the literature on the topic. The time interval between shunt surgery and detection of bowel perforation is minimum in infants and increases with age. Sigmoid and transverse colon followed by stomach are the most frequent sites of gastrointestinal perforations by VP shunts.

Gastrointestinal perforation in light chain amyloidosis in the era of novel agent therapy – a case series and review of the literature

Gastrointestinal (GI) perforation is remarkably rare in patients with light chain (AL) amyloidosis and has not yet been reported in patients with AL amyloidosis treated with novel agents. Only 24 cases of GI perforation have previously been reported in the setting of AL amyloidosis of which 15 had available information in English. All 15 did not receive novel agent therapy and six died early after experiencing GI perforation. This study reports the characteristics and outcome of AL patients that developed GI perforation in the era of novel agent treatment. Seven patients were reviewed. In two patients, GI perforation was the presenting symptom of AL amyloidosis, whereas five patients developed GI perforations following initiation of an anti-AL therapy (three after bortezomib-based, 1 after lenalidomide-based and 1 after thalidomide-based therapy). All patients underwent surgery and survived the perforation. Treatment was renewed following surgery in six of seven patients, with no further GI complications. In conclusion, GI perforation in AL amyloidosis is rare and mostly reported after treatment initiation. Urgent surgery appears to be lifesaving and renewal of the anti-AL novel therapy appears to be safe, with no significant risk for re-perforation or GI toxicity. Prognosis in these patients is related to severity of the disease and response to therapy rather than the development of GI perforation.

P-167 - Efficacy and tolerance of XELOX plus bevacizumab as first line therapy in Moroccan patients with metastatic colorectal cancer

Introduction: To evaluate the efficacy and safety of bevacizumab when added to XELOX (capecitabine plus oxaliplatin) in Moroccan patients with metastatic colorectal cancer (MCRC). Methods: All patients treated for MCRC with bevacizumab 7.5 mg/kg/3 weeks plus XELOX (oxaliplatin 130 mg/m2/3weeks and capecitabine 1000mg/m2 twice daily 14/21) between January 2013 and December 2016, in Military Hospital Mohamed V (Rabat Morocco) were investigated retrospectively. Assessment of tumor response was based on comparative CT scan (RECIST criteria). Adverse events were graded according to classification of the National Cancer Institute Common Toxicity Criteria. Results: The study included 58 patients (male/female 35/23; median age 56.4 years; age range 28 76 years; PS 0/1/2:10/46/2). The median number of cycle of oxaliplatin was 6.4 (range: 39). The objective response rate was 56.8% (complete response in 2 cases (3.4%) and partial response in 31 cases (53.4%)). The median progression-free survival was 9.9 months (95 % CI 3 15).The most frequent grade 3 and 4 adverse events were aspartate aminotransferase elevation (19 %), alanine aminotransferase elevation (17.2%), anemia (13.8%), neutropenia (12%), fatigue (8.6%), hypertension (5.1%), peripheral neuropathy (3.4%), thromboembolic complications (3.4%) and one case of gastro-intestinal perforation. Conclusion: First line treatment with XELOX plus bevacizumab showed a promising response rate and an acceptable tolerability profile in the clinical practice of Moroccan metastatic colorectal cancer patients.

A Case Against Fancy Decorated Drinks: Multi-Organ Failure After Drinking a Mojito Cocktail.

We present the first case of gastro-intestinal perforation caused by a mint twig decorating a cocktail drink. A 76-year-old man was enjoying his Mojito cocktail on a cruise ship near Mexico when he accidently swallowed a mint twig, resulting in ileum perforation. This led to a cascade of events, eventually resulting in life-threatening multi-organ failure. Given this rare but potentially severe complication and the increasing popularity of decorated drinks, a less ‘fancy’ presentation for cocktails and similar drinks may be warranted.LEARNING POINTSAccidental ingestion of a foreign body is relatively common.Although rare, the presence of foreign bodies in the gastro-intestinal tract can result in an acute surgical abdomen requiring emergency surgery.Drinks decorated with plant twigs may be a risk factor for an acute surgical abdomen and consequently are not recommended.

Severe gastrointestinal bleeding due to erlotinib and celecoxib therapy: additional effect?

Non-small cell lung cancer (NSCLC) is the leading cause of cancer related dead worldwide and account for over 85% of all lung cancers. Furthermore, the majority of patients with NSCLC present with advanced, metastatic disease at the time of diagnosis. For most patients with non-small cell lung cancer, current treatments do not cure the cancer. Therefore, there is a great need for development of more effective therapies. The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) like erlotinib and gefitinib have been recognized as an important molecular target in cancer therapy and they are approved for the treatment of refractory advanced NSCLC patients. EGFR TKIs are generally well tolerated. The two most common toxicities include dermatologic and gastrointestinal side effects. Cases of gastrointestinal perforation, some of which were fatal, have also been reported in patients receiving erlotinib. Those at increased risk include those taking concomitant anti-angiogenic agents, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or taxane-based chemotherapy, or who have prior history of peptic ulceration or diverticular disease.

Abstract P2-16-03: Mature results on metastatic breast cancer patients with prolonged (≥1 year) exposure to first-line bevacizumab combined with paclitaxel from a large observation study

Abstract Background: Bevacizumab (BEV) combined with chemotherapy (CT) significantly improves progression-free survival (PFS) and response rate (RR) vs CT alone in the 1st-line treatment of HER2-negative metastatic breast cancer (mBC). BEV was continued for ≥1 year in 20% of patients (pts) in the global ATHENA safety study. We examined a similar subgroup of pts with long-term antibody treatment in a large German observation study. Meanwhile, long-term follow-up of up to 4.5 years allows to present the final results, including mature data on overall survival. Methods: Pts who had received no prior CT for their mBC received BEV-PAC per the European label. Efficacy and safety were documented in detail for up to 1 year (or until progression, death, or BEV discontinuation if earlier), with subsequent retrieval of long-term follow-up. Results: By April 2013, final data were available for 865 pts, of whom 167 (20%) were recorded to have received BEV for ≥1 year. Baseline characteristics of this subset relative to the overall population are summarized in the table. CharacteristicOverall population (n = 865)Subgroup treated with BEV for ≥1 year (n = 167)Median age, years (range)58(26-87)57(28-79)Age ≥65 years,%3230Metastatic at diagnosis,%2018Disease-free inreval <12 months,%24*14#Liver metastasis,%4235≥3 metastatic sites,%3329Triple-negative disease,%1812ECOG performance status >1,%98Prior (neo)adjuvant chemotherapy,%6661*n = 591, initially M0. #n = 113 Dose reductions of long-term BEV occurred in only 3% of cycles and (at least once) in 17% of pts. In the majority of pts treated for ≥1 year, BEV was continued as a single agent after discontinuation of CT. The overall best RR in pts treated for ≥1 year was 80% (complete response in 19%). Median PFS, based on observed events in 83% of all pts, was 18.4 months compared to 9.6 months in the overall population. Overall survival data, based on 524 deaths (61%), show a median of 21.6 months. In the subgroup with prolonged therapy, median OS amounts to 35.7 months with 40% of pts still alive after 4 years. Safety of long-term BEV is as previously reported with only a slightly increased hypertension rate (35%, grade ≥3: 11%), and no cases of gastrointestinal perforation, arterial thromboembolic event, or reversible posterior leukoencephalopathy syndrome. Conclusions: According to the mature data of this study, including those on OS, a notable proportion of pts appear to derive benefit from prolonged exposure to first-line BEV-containing therapy. Although baseline characteristics exhibited only moderate indicators for an a priori more favorable prognostic profile in the subset of pts treated for ≥1 year, of course one has to keep in mind, that time-related efficacy data are biased towards improved outcome in those able to continue BEV for ≥1 year. However, the median survival of almost 3 years suggests that in a considerable number of pts continued first-line BEV-PAC correlates to favorable outcomes with limited adverse effects. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-03.

Cushing's disease presenting with gastrointestinal perforation: a case report

Gastrointestinal perforation is a complication associated with steroid therapy or hypercortisolism, but it is rarely observed in patients with Cushing's disease in clinical practice, and only one case has been reported as a presenting symptom. Herein, we report a rare case of Cushing's disease in which a patient presented with gastrointestinal perforation as a symptom. A 79-year-old man complained of discomfort in the lower abdomen for 6 months. Based on the endocrinological and gastroenterological examinations, he was diagnosed with Cushing's disease with a perforation of the descending colon. After consultation with a gastroenterological surgeon, it was decided that colonic perforation could be conservatively observed without any oral intake and treated with parenteral administration of antibiotics because of the mild systemic inflammation and lack of abdominal guarding. Despite the marked elevated levels of serum cortisol, oral medication was not an option because of colonic perforation. Therefore, the patient was submitted to endonasal adenomectomy to normalize the levels of serum cortisol. Subsequently, a colostomy was successfully performed. Despite its rarity, physicians should be aware that gastrointestinal perforation may be associated with hypercortisolism, especially in elderly patients, and immediate diagnosis and treatment of this life-threatening condition are essential. If a perforation can be conservatively observed, endonasal adenomectomy prior to laparotomy is an alternative treatment option for hypercortisolism.Learning points Thus far, only one case of gastrointestinal perforation as a presenting clinical symptom of Cushing's disease has been reported.Physicians should be aware that gastrointestinal perforation might be associated with hypercortisolism in elderly patients because elevated levels of serum cortisol may mask the clinical signs of perforation. Because of this masking effect, the diagnosis of the perforation also tends to be delayed.Although parenteral administration of etomidate is a standard treatment option for decreasing the elevated levels of serum cortisol, endonasal adenomectomy prior to laparotomy is an alternative treatment option if etomidate therapy is unavailable.

Efficacy and safety results from OCTAVIA, a single-arm phase II study evaluating front-line bevacizumab, carboplatin and weekly paclitaxel for ovarian cancer

PurposeThe single-arm OCTAVIA study evaluated front-line bevacizumab plus weekly paclitaxel and q3w carboplatin. Patients and methodsPatients with newly diagnosed ovarian cancer (International Federation of Gynecology and Obstetrics [FIGO] stage IIb–IV or grade 3/clear-cell stage I/IIA) received bevacizumab (7.5mg/kg, day 1), weekly paclitaxel (80mg/m2 days 1, 8, 15) and carboplatin (area under the curve 6 [AUC6], day 1) intravenously q3w for 6–8 cycles, followed by single-agent bevacizumab (total 1year). The primary objective was to demonstrate median progression-free survival (PFS)>18months according to the lower 90% confidence limit. Secondary end-points included objective response rate, overall survival, safety and tolerability. ResultsMost (74%) of the 189 treated patients had stage IIIC/IV disease, similar to the ICON7 population. Patients received a median of six chemotherapy and 17 bevacizumab cycles. At the predefined cutoff 24months after last patient enrolment, 99 patients (52%) had progressed and 19 (10%) had died, all from ovarian cancer. Median PFS was 23.7months (95% confidence interval [CI], 19.8–26.4months), 1-year PFS rate was 85.6%, Response Evaluation Criteria in Solid Tumors (RECIST) response rate was 84.6% and median response duration was 14.7months. Most patients (⩾90%) completed at least six chemotherapy cycles. Grade ⩾3 peripheral sensory neuropathy occurred in 5% and febrile neutropenia in 0.5%. Grade ⩾3 adverse events typical of bevacizumab were no more common than in phase III bevacizumab ovarian cancer trials. There was one case of gastrointestinal perforation (0.5%) and no treatment-related deaths. ConclusionOCTAVIA met its primary objective, demonstrating median PFS of approximately 2years. This bevacizumab-containing regimen is active and tolerable.

Two cases of gastrointestinal perforation after radiotherapy in patients receiving tyrosine kinase inhibitor for advanced renal cell carcinoma

We report two cases of gastrointestinal perforation (GIP) after radiotherapy in patients receiving tyrosine kinase inhibitor (TKI) for advanced renal cell carcinoma (RCC). Case 1 was a 61-year-old woman with lung metastases after a radical nephrectomy for a right RCC (cT3aN0M0) treated with interferon-alpha (OIF, 5 MIU, three times per week). She developed lytic metastases of the left femur and the left acetabulum. She was treated with palliative radiotherapy to the metastatic portion (3 Gy × 10 fractions), and 400 mg sorafenib twice per day plus continuing interferon alpha. She experienced sudden left lower abdominal pain after four weeks of treatment, and was diagnosed with a perforation of the sigmoid colon with fecal peritonitis. Case 2 was a 48-year-old man with lung, lymph node, and bone metastases after a radical nephrectomy for a right RCC (cT2N0M0), and was treated with 400 mg sorafenib twice per day. He developed lytic bone metastases of the lumbar vertebrae, which was treated with palliative radiotherapy to L2-4 (3 Gy × 10 fractions). He experienced sudden abdominal pain after two months of radiation treatment, and was diagnosed with a perforation of the sigmoid colon with fecal peritonitis. These cases underwent radiotherapy, and therefore this may be related to the radiosensitivity of TKI.

P-0136 10 Cases of Non-Hodgkin's Lymphoma that Caused Gastrointestinal Perforation - Experience in our Department

ABSTRACT Introduction It is common that malignant lymphoma infiltrates the digestive tract. It may also cause gastrointestinal perforation after initial chemotherapy, resulting from its good response to the therapy. We report our experience with 10 patients who developed gastrointestinal perforation while being observed for malignant lymphoma. Methods In the case that hematologic malignancy was diagnosed in our hospital by 1990 from 2011. We intended to consider the 10 cases of gastrointestinal perforation about diagnosis, age, gender, pathological classification, clinical stage of malignant lymphoma, time of perforation, location, therapy and prognosis. Results The ratio of men to women was 8:2 and the median age was 64 years (range: 40 to 77 years). The histopathologic type was non-Hodgkin's lymphoma in all cases, with a subtype of T-cell leukemia/lymphoma (ATLL) in 1 case, follicular lymphoma (grade 2) in 1 case, diffuse large B-cell lymphoma in 6 cases, diffuse large T-cell lymphoma in 1 case, and diffuse mixed lymphoma (B-cell ) in 1 case. According to the Ann Arbor staging system, the clinical stage was IA in 1case, IE in 1 case, IIIE in 1 case, IVA in 3 cases, and IVB in 4 cases. Perforation occurred prior to chemotherapy in 2 cases, after completion of the first cycle of chemotherapy in 3 cases, after 4 cycles in 1 case, after 6 cycles in 2 cases, during the advanced stage of chemotherapy-refractory lymphoma in 1 case, and during recurrence after complete response in 1 case. The site of perforation was the stomach in 2 cases, the duodenum in 1 case, the jejunum in 2 cases, and the ileum in 5 cases. After the occurrence of perforation, a total of 8 patients underwent urgent laparotomy. Causes of death and duration of survival after perforation, of the 10 patients, 7 patients died. The cause of death was diffuse peritonitis in 4 cases and side effect of postoperative chemotherapy in 2 cases such as gastrointestinal hemorrhage, serious infection, 1 case achieved unconfirmed complete remission, but relapsed after 2years and indicated refractory to chemotherapy and died. 3 cases achieved complete response after finishing seven cycles of chemotherapy following emergency surgery. These cases are now being followed on an outpatient basis. The median survival in all patients was 13 days (range: 6 to 716 days). Conclusion The reason for the relatively high frequency of small intestine perforation is that the small intestine is originally devoid of cell-to-cell adhesiveness and lymphocytes, which do not produce extracellular matrix and proliferate without producing connective tissues involving the whole thickness, resulting in coarse cell junctions in the intestinal tract wall. In conclusion, according to our experience, it was suggested that curative resection is not mandatory in patients undergoing surgery for gastrointestinal perforation associated with malignant lymphoma and it is important to start chemotherapy in the early postoperative period and select a safer surgical procedure, such as limited surgery, that prioritizes patients' survival according to their individual general condition, flexibly assessing the necessity of removing the lesions.

P1-14-04: Prolonged (≥1 Year) Exposure to First-Line Bevacizumab Combined with Paclitaxel in Patients with HER2−Negative Metastatic Breast Cancer Treated in a Routine Oncology Practice Study.

Abstract Background: First-line bevacizumab (BEV) combined with weekly paclitaxel (PAC) significantly improves progression-free survival (PFS) and response rate (RR) vs PAC alone in HER2−negative metastatic breast cancer (mBC), as shown in E2100. The benefit of BEV combined with other chemotherapy (CT) agents was demonstrated in AVADO and RIBBON-1. BEV was continued for ≥1 year in 21% of patients in the global ATHENA safety study and in 42% of patients in the JO19901 single-arm Japanese study of BEV-PAC. We analyzed data from the subgroup of patients treated for ≥1 year in a German routine oncology practice study to provide insight into the safety and efficacy of prolonged first-line BEV-PAC. Methods: Patients who had received no prior CT for their mBC received BEV-PAC per the European label. Efficacy and safety were documented for up to 1 year (or until progression, death, or BEV discontinuation if earlier) with additional long-term follow-up. Data from patients treated with BEV for ≥1 year were extracted for this analysis. Results: By Jan 2011, data were available for 818 patients, of whom 157 (19%) had already received BEV for ≥1 year. Baseline characteristics of this subset relative to the overall population are summarized in the table. In 79% of those treated for ≥1 year, BEV was continued as a single agent after discontinuation of CT. The overall RR in patients treated for ≥1 year was 81% (complete response in 20%). Median PFS was 17.9 months (events in 44% of patients) vs 9.4 months in the overall population (events in 68%). Overall survival data are immature, as 81% of those treated for ≥1 year are still alive. The most common grade 3/4 adverse events in patients treated with BEV for ≥1 year were hypertension (11% of patients), pain (10%), and leukopenia (7%). There were no cases of gastrointestinal perforation, arterial thromboembolic event, or reversible posterior leukoencephalopathy syndrome in those treated for≥1 year. Analysis of adverse events according to time of onset is ongoing. Conclusions: A notable proportion of patients appear to derive benefit from prolonged exposure to first-line BEV-containing therapy. In the present analysis, baseline characteristics appeared more favorable in the subset of patients treated for ≥1 year than in the overall population. Efficacy data clearly have a bias towards improved outcome in those able to continue BEV for ≥1 year, as these patients had sustained disease control for ≥1 year. However, the efficacy of prolonged BEV-containing therapy is of interest and suggests that some patients achieve sustained disease control with continued first-line BEV-PAC with limited side effects. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-14-04.

Successful Application of the Vacuum-Assisted Closure System in Delayed Primary Closure: A Case of Gastrointestinal Perforation

Successful Application of the Vacuum-Assisted Closure System in Delayed Primary Closure: A Case of Gastrointestinal Perforation