- Email: [email protected]
An unusual bowel complication during molecularly-targeted therapy
Digestive and Liver Disease 47 (2015) e20
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
An unusual bowel complication during molecularly-targeted therapy Kensuke Adachi a,∗ , Shoichi Okamoto b a b
Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
Fig. 1.
A 66-year-old woman with metastatic lung adenocarcinoma was admitted because of nausea and vomiting which she began experiencing a month after commencing third-line chemotherapy with orally-active, molecularly-targeted gefitinib. During the chemotherapy, only gefitinib was administered to the patient. A computed tomography (CT) with intravenous contrast detected extensive intraluminal gas along the small intestine and a pneumoperitoneum (Fig. 1, arrows), but no bowel obstruction or ischaemia was observed. The intraluminal gas was consistent with linear pneumatosis intestinalis (PI) although a serial CT during the course of her disease denied these features. An assessment based on our findings was sufficient for the diagnosis of pneumoperitoneum due to benign PI.
∗
Corresponding author at: Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. Tel.: +81 42 323 5111; fax: +81 42 323 9209. E-mail address: kensuke [email protected] (K. Adachi).
Fig. 2.
The patient was treated conservatively by discontinuing gefitinib, prohibiting oral intake, and administering a course of intravenous prophylactic antibiotics. Although the patient was closely monitored, her condition remained stable and without incident. She resumed oral intake 3 days later and was discharged after ten days. A CT performed before her discharge revealed a complete resolution of the PI and pneumoperitoneum (Fig. 2). Given the time course of resolution and her disease history, gefitinib might have played a major role in the development of the PI and pneumoperitoneum. Awareness of this entity and therapeutic rationale will help steer clinicians towards timely, appropriate management, and avoid unnecessary laparotomies [1]. Reference [1] Guiu S, Ortega-Deballon P, Guiu B. Pneumatosis intestinalis and pneumoperitoneum during treatment by paclitaxel. Surgery 2011;149:297–8.
http://dx.doi.org/10.1016/j.dld.2015.06.017 1590-8658/© 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
An unusual bowel complication during molecularly-targeted therapy Kensuke Adachi a,∗ , Shoichi Okamoto b a b
Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
Fig. 1.
A 66-year-old woman with metastatic lung adenocarcinoma was admitted because of nausea and vomiting which she began experiencing a month after commencing third-line chemotherapy with orally-active, molecularly-targeted gefitinib. During the chemotherapy, only gefitinib was administered to the patient. A computed tomography (CT) with intravenous contrast detected extensive intraluminal gas along the small intestine and a pneumoperitoneum (Fig. 1, arrows), but no bowel obstruction or ischaemia was observed. The intraluminal gas was consistent with linear pneumatosis intestinalis (PI) although a serial CT during the course of her disease denied these features. An assessment based on our findings was sufficient for the diagnosis of pneumoperitoneum due to benign PI.
∗
Corresponding author at: Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. Tel.: +81 42 323 5111; fax: +81 42 323 9209. E-mail address: kensuke [email protected] (K. Adachi).
Fig. 2.
The patient was treated conservatively by discontinuing gefitinib, prohibiting oral intake, and administering a course of intravenous prophylactic antibiotics. Although the patient was closely monitored, her condition remained stable and without incident. She resumed oral intake 3 days later and was discharged after ten days. A CT performed before her discharge revealed a complete resolution of the PI and pneumoperitoneum (Fig. 2). Given the time course of resolution and her disease history, gefitinib might have played a major role in the development of the PI and pneumoperitoneum. Awareness of this entity and therapeutic rationale will help steer clinicians towards timely, appropriate management, and avoid unnecessary laparotomies [1]. Reference [1] Guiu S, Ortega-Deballon P, Guiu B. Pneumatosis intestinalis and pneumoperitoneum during treatment by paclitaxel. Surgery 2011;149:297–8.
http://dx.doi.org/10.1016/j.dld.2015.06.017 1590-8658/© 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.