Akeel Nouf, Toonsi Wafaa A
Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.
Cureus. 2021 Jan 21;13(1):e12831. doi: 10.7759/cureus.12831.
Intestinal obstruction is a common acute presentation of advanced rectal cancer, which could be managed with surgical or non-surgical techniques including metallic stenting. Bevacizumab has been gaining popularity in the treatment of advanced colorectal cancer (CRC) in combination with different chemotherapeutic agents, to improve the overall survival rate; however, data regarding the adverse effects of bevacizumab in combination with other treatment modalities have been insufficient. Herein, we present a case of a 37-year-old man diagnosed with advanced rectal cancer with concurrent liver and lung metastases. He was started on Xelox (capecitabine plus oxaliplatin) chemotherapy in combination with bevacizumab for palliative care. He developed an episode of bowel obstruction, which was managed with emergent placement of a metallic stent. Soon after that, the patient presented emergently with signs and symptoms of intestinal perforation. He underwent emergent surgical intervention with stoma creation and a complicated hospital course. Despite the oncological benefits of bevacizumab for treating metastatic CRC, complications can occur resulting in a devastating outcome, with intestinal perforation being the most serious rare complication.
肠梗阻是晚期直肠癌常见的急性表现，可通过包括金属支架置入术在内的手术或非手术技术进行处理。贝伐单抗与不同化疗药物联合用于晚期结直肠癌（CRC）治疗，以提高总生存率，目前越来越受到青睐；然而，关于贝伐单抗与其他治疗方式联合应用的不良反应的数据尚不充分。在此，我们报告一例37岁男性患者，诊断为晚期直肠癌并伴有肝肺转移。他开始接受希罗达（卡培他滨加奥沙利铂）化疗联合贝伐单抗进行姑息治疗。他出现了一次肠梗阻发作，通过紧急置入金属支架进行处理。此后不久，患者紧急出现肠穿孔的体征和症状。他接受了紧急手术干预，进行了造口术，病程复杂。尽管贝伐单抗对治疗转移性CRC有肿瘤学益处，但仍可能发生并发症，导致灾难性后果，肠穿孔是最严重的罕见并发症。
