A Case Report of Intestinal Perforation in a Patient with Metastatic Rectal Cancer during Bevacizumab Treatment

Keiji Hirata, Takayuki Tanoue, Kohichi Arase, Kazunori Shibao, Aiichiro Higure, Yoshifumi Nakayama, Naoki Nagata and Koji Yamaguchi

Department of Surgery 1, University of Occupational and Environmental Health

A 53-year-old man undergoing Miles operation and systemic chemotherapy (FOLFIRI) for advanced rectal cancer with simultaneous liver metastasis then underwent 6 courses of bevacizumab combined with FOLFOX chemotherapy. The second day after the final administration of bevacizumab, he presented right lower abdominal pain with fever. CT showed inflammatory change in the ileocecal region with cecal diverticula and presence of free air. Ileocecal resection with simultaneous anastomosis were immediately performed under a diagnosis of diverticular perforation during bevacizumab treatment. The postoperative course was uneventful except for delayed incisional healing. Bevacizumab, a recombinant humanized monoclonal IgG1 antibody that binds to and inhibits the biological activity of human vascular endothelial growth factor, when combined with intravenous 5-fluorouracil-based chemotherapy, is indicated for first- or second-line treatment of patients with metastatic carcinoma of the colon or rectum. Since diverticulitis is a risk factor for intestinal perforation during bevacizumab treatment, caution must be exercised when bevacizumab is given to patients with intestinal diverticuli.

Key words
metastatic colorectal cancer, bevacizumab, intestinal perforation

Reprint requests
Keiji Hirata Department of Surgery 1, University of Occupational & Environmental Health
1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 JAPAN

Accepted
June 18, 2008

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