Korean J Gastroenterol.  2013 Jun;61(6):347-350. 10.4166/kjg.2013.61.6.347.

A Case of Pneumatosis Intestinalis Associated with Sunitinib Treatment for Renal Cell Carcinoma

  • 1Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea. sypark1011@hotmail.com


Sunitinib as a multitarget tyrosine kinase inhibitor is one of the anti-tumor agents, approved by the United States Food and Drug Administration to use treat gastrointestinal stromal tumor and metastatic renal cell carcinoma. The agent is known to commonly induce adverse reactions such as fatigue, nausea, diarrhea, stomatitis, esophagitis, hypertension, skin toxicity, reduciton in cardiac output of left ventricle, and hypothyroidism. However, it has been reported to rarely induce adverse reactions such as nephrotic syndrome and irreversible reduction in renal functions, and cases of intestinal perforation or pneumatosis interstinalis as such reactions have been consistently reported. In this report, a 66-year old man showing abdominal pain had renal cell carcinoma and history of sunitinib at a dosage of 50 mg/day on a 4-weeks-on, 2-weeks-off schedule. Seven days after the third cycle he was referred to the hospital because of abdominal pain. Computed tomography showed pneumoperitoneum with linear pneumatosis intestinalis in his small bowel. The patient underwent surgical exploration that confirmed the pneumatosis intestinalis at 100 cm distal to Treitz's ligament. We report a rare case of intestinal perforation with pneumatosis intestinalis after administration of sunitinib to a patient with metastatic renal cell carcinoma.


Pneumatosis Intestinalis; Sunitinib; Advanced renal cell carcinoma

MeSH Terms

Antineoplastic Agents/adverse effects/*therapeutic use
Carcinoma, Renal Cell/*drug therapy
Drug Administration Schedule
Indoles/adverse effects/*therapeutic use
Intestinal Perforation/*diagnosis/etiology/surgery
Kidney Neoplasms/*drug therapy
Pneumatosis Cystoides Intestinalis/*diagnosis/etiology
Positron-Emission Tomography
Pyrroles/adverse effects/*therapeutic use
Tomography, X-Ray Computed
Antineoplastic Agents


  • Fig. 1. Chest radiography showed free air (black arrow) at perihepatic area.

  • Fig. 2. Abdomen radiography showed small bowel dilatation.

  • Fig. 3. Abdominal CT. (A) CT scan showed linear pneumatosis (black arrow) in the small bowel without associated soft-tissue bowel wall thickening. (B) CT scan showed linear rings of pneumatosis (white arrow) in the small bowel. (C) CT scan showed pneumoperitoneum (white arrow).



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