A Case of Colonic Perforation at the Anastomotic Site associated with Bevacizumab

Yoshihiko Nakamoto, Yuichiro Kikawa, Itirou Yuasa, Takehisa Harada, Masahiko Takeo, Masaaki Ogata and Mitsuo Yamamoto

Department of Surgery, Kobe City Medical Center West Hospital

The patient was a 33-year-old woman diagnosed to have colon cancer with multiple liver metastases. In June 2007, she underwent laparoscopic-assisted colectomy with functional-end-to-end anastomosis using 4 linear staplers. On postoperative day 21, she was initiated on chemotherapy with FOLFOX6 (5-fluorouracil, leucovorin, and oxaliplatin). She also received bevacizumab on postoperative day 60 and day 74. On postoperative day 78, she developed acute abdominal pain, and CT showed the presence of free air in the abdomen. Under the diagnosis of peritonitis due to gastrointestinal perforation, an emergency operation was conducted. Surgical exploration showed a perforation at the anastomotic site of the stapler, therefore, the portion of the colon containing this anastomotic site was resected and transverse colostomy was performed. Thereafter the patient developed wound and abdominal infection with suspected gastrointestinal reperforation, and increase in the size of the liver metastases was noted. On postoperative day 107, she died. Attention should be paid to the major complication of gastrointestinal perforation associated with the use of bevacizumab; this is the first case report of its resulting in death in Japan.

Key words
Bevacizumab, gastrointestinal perforation, functional end-to-end anastomosis

Reprint requests
Yoshihiko Nakamoto Department of Surgery, Kobe City Medical Center West Hospital
2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 JAPAN

Accepted
July 23, 2008

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