Case report of perforation of an ileal neobladder after treatment of rectal cancer with bevacizumab and comment on mechanisms of intestinal perforation associated with bevacizumab

Late anastomotic breakdown with bevacizumab in colorectal cancers, a case-based review

BACKGROUND

Bevacizumab is the first angiogenesis inhibitor to be approved for metastatic colorectal cancer. Unfortunately, bevacizumab treatment has been associated with a variety of complications including haemorrhage, poor wound healing and gastrointestinal perforation. Late anastomotic breakdown related to bevacizumab therapy however has rarely been described.

CASE REPORT

Here, we present the case of a 56-year-old woman who had a bevacizumab-related anastomotic breakdown 17 months following her primary anastomosis. She initially underwent an emergency Hartmann's procedure and two further laparotomies for significant intra-abdominal haemorrhage. Despite the best efforts of the surgical and intensive care teams, ultimately, the patient passed away.

DISCUSSION

There is a small but growing body of literature relating to bevacizumab use and late anastomotic breakdown. It would seem prudent to take extra caution when using bevacizumab in those patients with previous pelvic irradiation, who have a rectal site of anastomosis or have experienced a previous anastomotic leak.

Case Report: A Neocystostomy Perforation Presenting as a Gallstone

An 83-year-old man, with a surgical history of radical cystectomy with simultaneous construction of a neobladder 13 years ago, presented clinically and radiologically as acute cholecystitis. Upon emergent exploratory laparotomy for his acute deterioration, a perforated neobladder was identified with its spilled stones in the gallbladder fossa, mimicking acute cholecystitis. This is the first case report of this presentation. Neobladder perforations should be considered in any patient who has undergone orthotopic bladder substitution, no matter how long it has been since the original reconstruction.

Extensive bowel necrosis related to bevacizumab in metastatic rectal cancer patient: a case report and review of literature

Recently, bevacizumab has become a key drug for treatment of metastatic colorectal cancer. Molecularly targeted agents such as bevacizumab can cause life-threatening adverse effects, though they are generally considered less toxic than cytotoxic drugs. Here, we review the case of a 76-year-old male rectal cancer patient with liver metastasis who suffered extensive bowel necrosis after administration of 5-fluorouracil-based chemotherapy with bevacizumab, and required a subtotal colectomy and end-ileostomy. Microscopic findings revealed extensive mucosal necrosis in the resected colon specimen and necrosis at the muscularis propria of the descending colon. Pathological findings suggested that the mucosal damage induced by chemotherapy may be exacerbated by treatment with bevacizumab, resulting in extensive necrosis.