Catholic University of Sacred Heart, Agostino Gemelli Medical School, Rome, Italy.
Curr Med Res Opin. 2010 Mar;26(3):707-11. doi: 10.1185/03007990903566798.
Acute abdominal symptoms with CT scan evidence of intramural gas in bowel walls (pneumatosis cystoides intestinalis, PCI) and of gas in the portal venous blood (PBG) in patients undergoing chemotherapy may represent a worrisome picture, suggestive of bowel necrosis. This picture remains a major clinical clue and the reporting of new cases may help to share awareness and experience on management. We describe a patient with acute abdominal symptoms and evidence of PCI with PBG under cetuximab, oxaliplatin, tegafur-uracil and folinic acid chemotherapy for metastatic adenocarcinoma of the rectosigmoid junction.
After admission for mucositis with diarrhea and profound dehydration, and subsequent emergency laparotomy for derotation of an intestinal volvulus, on the tenth postoperative day the patient developed fever and abdominal pain, with CT scan evidence of PCI with PBG. The exam of the abdomen did not suggest major problems requiring emergency surgery, and antibiotic treatment with close monitoring were performed, followed by rapid improvement.
Twelve days later, after resumption of oral diet, the patient unexpectedly suffered a spontaneous jejunal microperforation, requiring emergency laparotomy and bowel resection. Pathology showed that the perforation was within an area of ulceration involving the inner superficial layer of the bowel. Subsequently recovery was normal and at present, after 15 months, the patient is well and continuing chemotherapy.
This is probably the first report of PCI with PBG related to intestinal toxicity during cetuximab, oxaliplatin, tegafur-uracil and folinic acid chemotherapy in a patient with advanced rectal carcinoma, followed by delayed small bowel perforation. It provides an example of the challenges involved in the management of this type of patient.
在接受化疗的患者中，腹部 CT 扫描显示肠壁内有气体（气囊肿病，PCI）和门静脉血液中有气体（PBG）的急性腹部症状可能代表一种令人担忧的情况，提示肠坏死。这种情况仍然是一个主要的临床线索，报告新病例可能有助于分享对这种情况的管理意识和经验。我们描述了一例接受曲妥珠单抗、奥沙利铂、替加氟-尿嘧啶和亚叶酸钙化疗的直肠乙状结肠交界处转移性腺癌患者出现急性腹痛症状和 PCI 伴 PBG 的病例。
患者因黏膜炎伴腹泻和严重脱水入院，随后因肠扭转行紧急剖腹术，术后第 10 天出现发热和腹痛，腹部 CT 扫描显示 PCI 伴 PBG。腹部检查未提示需要紧急手术的重大问题，给予抗生素治疗并密切监测，随后病情迅速改善。
12 天后，患者恢复口服饮食后，突然发生自发性空肠微穿孔，需要紧急剖腹手术和肠切除。病理检查显示穿孔位于累及肠内层浅层的溃疡区域内。随后患者恢复正常，目前，15 个月后，患者状况良好，继续接受化疗。
这可能是首例报告曲妥珠单抗、奥沙利铂、替加氟-尿嘧啶和亚叶酸钙化疗治疗晚期直肠癌患者出现 PCI 伴 PBG 相关肠毒性，随后发生迟发性小肠穿孔的病例。它提供了一个管理此类患者所面临挑战的范例。
