Reactions 1704, p66 - 2 Jun 2018 Anastomotic breakdown, intra abdominal haemorrhage and haemodynamic instability: case report A 56-year-old woman developed rectal anastomotic breakdown, intra abdominal haemorrhage and haemodynamic instability following treatment with bevacizumab [route and time to reaction onset not stated]. She subsequently died due to haemodynamic instability. The woman had been diagnosed with rectal cancer in July 2013, following which she received treatment with chemoradiotherapy. She underwent a low anterior resection for her primary anastomosis in November 2013. Routine surveillance computed tomography (CT) scan in November 2014 revealed hepatic metastases. She subsequently received treatment with bevacizumab 5 mg/kg, along with other chemotherapeutic drugs between January 2015 and March 2015. She received three doses of bevacizumab and the last dose administered in the first week of March 2015. She was hospitalised in April 2015, as she had been experiencing worsening abdominal pain for the past week and diarrhoea, along with occasional bleeding per rectum for the past month. The abdominal and pelvic CT revealed a large pelvic abscess with air along the piriformis muscles. These findings were suggestive of significant anastomotic breakdown. The woman underwent an emergency laparotomy with excision of the anastomosis, oversewing of the rectal stump and formation of an end colostomy. She became haemodynamically unstable three days later and underwent and exploratory laparotomy, which revealed significant intra- abdominal haemorrhage primarily from the sacral plexus. The abdomen was packed and closed, following which she stabilised. Two days later, the abdominal packs were removed and the abdomen was found to be relatively dry. Over the coming days, she showed progressive haemodynamic unstablity. Her condition continued to worsen despite treatment with multiple transfusions of red blood cells and intensive care. A decision was made not to surgically intervene and she died due to haemodynamic instability in April 2015. Author comment: "We present the case of a 56-year-old woman who developed an anastomotic breakdown following initiation of bevacizumab for metastatic rectal cancer." "Bowel ischemia and necrosis, gastrointestinal perforation, haemorrhage, fistulous disease and wound healing complications have all been clearly associated with bevacizumab use." O’Hare T, et al. Late anastomotic breakdown with bevacizumab in colorectal cancers, a case-based review. Irish Journal of Medical Science 187: 333-336, No. 2, May 2018. Available from: URL: http://doi.org/10.1007/s11845-017-1676-y - Ireland 803323098 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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