[Chemotherapy-associated enterocolitis--a rare but potentially lethal side effect of adjuvant breast cancer treatment: a case report].
BACKGROUND
A 60-year-old patient underwent breast-preserving surgery for breast cancer of TNM stage pTla (m), pN2a (8/12), G2, pMO. After the operation, she received 4 cycles of epirubicin/cyclophosphamide (90/600 mg/m2), followed by 2 cycles of docetaxel (100 mg/m2). Four days after the second cycle of docetaxel, the patient presented with abdominal pain, nausea, vomiting and obstipation of 3 days' duration.


RESULTS
The physical examination showed a distended abdomen, absence of peristaltic sounds and pressure pain in the lower left abdomen. The laboratory examination was conspicuous for granulocytopenia of NCI grade Ill and an increased CRP concentration of 7.7 mg/dl.


METHODS
The main diagnosis was suspected chemotherapy-associated enterocolitis with signs of paralytic ileus; the latter was confirmed by computer tomography and laparotomy.


RESULTS
Primary treatment consisted of placing a stomach tube, infusion therapy, broad-spectrum antibiotics and G-CSF. Later on, 5 explorative laparotomies with abdominal lavage were performed due to deterioration of the general condition and suspicion of intra-abdominal compartment syndrome. After a temporary improvement, the patient died of protracted multi-organ failure 8 weeks after hospitalization.


CONCLUSIONS
Chemotherapy-associated enterocolitis is a very rare but potentially lethal side effect of cytostatic therapy. Therefore, gastrointestinal symptoms should be carefully noted in order to minimize the mortality risk by a timely therapeutic intervention.
I. Frauenklinik, Klinikum der Ludwig-Maximilians-Universität, Maistrasse 11, DE-80337 Munich, Germany. janni@fk-i.med.uni-muenchen.de
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D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000633:toxicity*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000633:toxicity; D000077143:Docetaxel; D004334:Drug Administration Schedule; D020345:Enterocolitis, Necrotizing / Q000139:chemically induced* / Q000175:diagnosis; D015251:Epirubicin / Q000008:administration & dosage / Q000633:toxicity; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D012086:Reoperation; D043823:Taxoids / Q000008:administration & dosage / Q000633:toxicity; D017211:Treatment Failure
D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide