Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
Department of Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia.
BMJ Case Rep. 2022 Apr 26;15(4):e247774. doi: 10.1136/bcr-2021-247774.
Osteosarcoma is the most common paediatric and adolescent primary bone malignancy and is highly chemosensitive. Gastrointestinal metastases from osteosarcomas are rare. Bowel perforation secondary to chemotherapy is a potential serious complication reported in ovarian, colorectal and haematological malignancies. We report the first documented case of chemotherapy-mediated bowel perforation in an osteosarcoma patient with gastrointestinal metastases. A man in his 20s, with a history of resected osteosarcoma in remission, presented with abdominal pain. A computed tomography (CT) scan demonstrated a large calcified intrabdominal mass (15×13×9 cm) consistent with new peritoneal disease. After one cycle of palliative ifosfamide and etoposide chemotherapy, he developed a large bowel perforation and neutropenic sepsis consequently requiring resection of the perforated mass. Chemotherapy-induced bowel perforation is a rare but serious complication that should be considered in patients with osteosarcoma, and other chemosensitive malignancies, with intra-abdominal metastases. Recommencement of systemic therapies after bowel complications must be assessed cautiously on a case-by-case basis.
骨肉瘤是最常见的小儿和青少年原发性骨恶性肿瘤，对化疗高度敏感。骨肉瘤胃肠道转移较为罕见。化疗引起的肠穿孔是卵巢癌、结直肠癌和血液恶性肿瘤等报道的一种潜在严重并发症。我们报告首例经化疗介导的胃肠道转移骨肉瘤患者发生肠穿孔。一名 20 多岁的男性，既往有缓解期骨肉瘤切除病史，出现腹痛。计算机断层扫描（CT）显示一个大的钙化腹腔肿块（15×13×9cm），符合新的腹膜疾病。在接受一个周期的姑息性异环磷酰胺和依托泊苷化疗后，他发生了大肠穿孔和中性粒细胞减少性败血症，随后需要切除穿孔的肿块。化疗引起的肠穿孔是一种罕见但严重的并发症，对于有腹腔内转移的骨肉瘤和其他化疗敏感的恶性肿瘤患者，应考虑这种并发症。在出现肠并发症后，必须根据具体情况谨慎评估重新开始全身治疗的可能性。
