Korean J Gastroenterol.  2011 Jul;58(1):42-46. 10.4166/kjg.2011.58.1.42.

A Case of Severe Bevacizumab-induced Ischemic Pancolitis, Treated with Conservative Management

• Lee HN
• Lee MA
• Kim SW
• Lim Y
• Lee H
• Lee HM
• Won HS
• Chun SH

• KMID: 1792814
• DOI: http://doi.org/10.4166/kjg.2011.58.1.42

Abstract

Bevacizumab (Avastin(R)) is a monoclonal antibody against the vascular endothelial growth factor (VEGF) receptor that increases the overall survival rate when added to standard chemotherapy regimens in patients with metastatic colorectal cancer. The known toxicities of bevacizumab are hypertension, proteinuria, wound healing complications, arterial thrombosis, bleeding, and gastrointestinal complications. Especially ischemic colitis can rapidly develop into bowel perforation, so an emergency operation often is needed. Recently, a 65-year-old male patient developed ischemic pancolitis after FOLFOX (85 mg/m2 Oxaliplatin, d1;200 mg/m2 Leucovorin, d1;400 mg/m2 5-FU iv bolus, d1-2;and 600 mg/m2 5-FU, d1-2, every two wk) and Bevacizumab combination chemotherapy was administered. However, he recovered after early conservative care without surgery. We report this case with a review of literature.

Keyword

Bevacizumab; Ischemic colitis; Colorectal cancer

MeSH Terms

Aged
Antibodies, Monoclonal, Humanized/administration & dosage/*adverse effects
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Colitis, Ischemic/*chemically induced/radiography
Colorectal Neoplasms/drug therapy/pathology
Drug Administration Schedule
Fluorouracil/administration & dosage
Humans
Intubation, Gastrointestinal
Leucovorin/administration & dosage
Male
Organoplatinum Compounds/administration & dosage
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Abdominal simple x-ray. It showed the distension of the transver-se colon, and small and large bowel ileus.

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  Fig. 2. Abdominal CT scan. It showed the concentric layers of low and high attenuation (double-halo sign) (white arrow) and mucosal and serosal enhancement with edematous and non-enhanced thickening of submucosal layer from the ascending colon to sigmoid colon without evidence of perforation, suggesting colonic ischemia.

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  Fig. 3. Abdominal simple x-ray. It showed no more colonic gas distension or ileus.

Reference

References

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