A Case of a Bevacizumab-Associated Penetration into the Mesocolon, undergoing Right Colectomy with Primary Anastomosis

Takaya Kobatake, Yoshiro Kubo, Tomohiro Nishina*, Hiroyuki Takahata**, Kouzi Ohta, Isao Nozaki, Minoru Tanada, Akira Kurita and Shigemitsu Takashima

Department of Surgery, Department of Internal Medicine* and Department of Pathology**, Division of Gastroenterology, National Hospital Organization Shikoku Cancer Center

We report a case of bevacizumab-associated perforation of the mesocolon. A 51-year-old man who had undergone palliative colon resection for descending colon cancer with paraaortic lymph node metastasis two years earlier, was treated with FOLFOX plus bevacizumab therapy as second-line chemotherapy for 13 months after FOLFIRI chemotherapy for 9 months. During cycle 17 of bevacizumab therapy, he was admitted for pain in the right lower abdomen and fever. Physical examination showed tenderness and peritoneal irritation in the right abdomen. Abdominal CT showed thickening of the ascending colon wall and bubbles in the ascending mesocolon. He was diagnosed with perforation of the colon necessitating emergency right colectomy with primary anastomosis. Histologic diagnosis showed perforation at a diverticulum. He was discharged without complications. Bevacizumab-associated perforation is rare but serious, requiring early diagnosis and management. The creation of a defunctional stoma is thought to be better upon early diagnosis, good general condition, and very localized peritonitis as in this case. Primary anastomosis may also be possible.

Key words
colorectal cancer, bevacizumab, gastrointestinal perforation

Reprint requests
Takaya Kobatake Department of Surgery, Shikoku Cancer Center Hospital
160 Minamiumemoto-cho, Matsuyama, 791-0280 JAPAN

Accepted
January 28, 2009

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