Korean J Gastroenterol.  2011 Apr;57(4):253-257. 10.4166/kjg.2011.57.4.253.

A Case of Portal Hypertension after the Treatment of Oxaliplatin Based Adjuvant-Chemotherapy for Rectal Cancer

• Heo J
• Shin KY
• Kwon YH
• Park SY
• Jung MK
• Cho CM
• Tak WY
• Kweon YO

• KMID: 1718407
• DOI: http://doi.org/10.4166/kjg.2011.57.4.253

Abstract

We report herein a case of 35-years-old woman in whom portal hypertension (esophageal varix and splenomegaly) developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for rectal cancer. She was transferred for the evaluation of etiology of new-onset portal hypertension. The esophageal varix and splenomegaly were absent before the oxaliplatin based adjuvant chemotherapy. Thorough history taking and serological exam revealed no evidence of chronic liver disease. Liver biopsy was done and there was no cirrhotic nodule formation. Instead, perivenular fibrosis was noted. Considering new development of esophageal varices and splenomegaly after 12 cycles of oxaliplatin-based adjuvant chemotherapy, we could conclude that portal hypertension in this patient were due to sinusoidal injury by oxaliplatin. Finally, we recommend regular follow-up with endoscopy and radiologic examination for checking the development of varices and for screening of varices and splenomegaly in patients with colo-rectal cancer who receive oxaliplatin-based chemotherapy.

Keyword

Portal hypertension; Esophageal varix; Splenomegaly; Oxaliplatin

MeSH Terms

Adult
Antineoplastic Agents/*adverse effects/therapeutic use
Chemotherapy, Adjuvant
Esophageal and Gastric Varices/chemically induced
Female
Fibrosis
Humans
Hypertension, Portal/chemically induced/*diagnosis
Liver/pathology
Organoplatinum Compounds/*adverse effects/therapeutic use
Positron-Emission Tomography
Rectal Neoplasms/*drug therapy/surgery
Splenomegaly/chemically induced
Tomography, X-Ray Computed

Figure

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  Fig. 1. Endoscopic exam showing moderate sized, blue colored, beaded esophageal varices.

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  Fig. 2. Abdominal computed tomographic finding of spleen. (A) Before operation and chemotherapy, the maximal spleen diameter was 103.41 mm. (B) After operation and chemotherapy (6 months after last chemotherapy), the maximal spleen diameter was 123.71 mm.

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  Fig. 3. Histologic finding of the liver parenchyma. It revealed mininal perivenular fibrosis without cirrhotic nodules (A: Masson's trichrome stain,×100; B: Masson's trichrome stain, ×400).

Reference

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