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

Ha Ni Lee; Myung-Ah Lee; Sang Woo Kim; Yejee Lim; Hwayoung Lee; Hae Min Lee; Hye Sung Won; Sang-Hoon Chun

doi:10.4166/kjg.2011.58.1.42

Journal List > Korean J Gastroenterol > v.58(1) > 1006899

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Lee, Lee, Kim, Lim, Lee, Lee, Won, and Chun: A Case of Severe Bevacizumab-induced Ischemic Pancolitis, Treated with Conservative Management

Case Report

Korean J Gastroenterol 2011;58(1):42-46.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.1.42

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

Ha Ni Lee, Myung-Ah Lee, Sang Woo Kim, Yejee Lim, Hwayoung Lee, Hae Min Lee, Hye Sung Won, Sang-Hoon Chun

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Myung-Ah Lee, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea. Tel: +82-2-2258-6044, Fax: +82-2-599-3589, E-mail: angelamd@catholic.ac.kr

Received 6 August 201020 September 2010 Accepted 23 September 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bevacizumab (Avastin^®) 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.

Keywords: Bevacizumab, Ischemic colitis, Colorectal cancer

References

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Fig. 1.

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

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.

Fig. 3.

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

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