title: [A case of rectal hemorrhage during chemotherapy with bevacizumab for local recurrence of rectal cancer].
abstract: Chemotherapy with bevacizumab(BV)has been one of the standard treatments for patients with metastatic colorectal cancer. However, emergent treatments are sometimes required because of severe adverse events associated with it. We experienced a case of massive rectal hemorrhage during BV treatment, and interventional radiology(IVR)successfully controlled it. An 81-year-old male visited our hospital, suffering from local recurrence of rectal cancer. He underwent colostomy for fecal diversion, and chemoradiation therapy was performed. Systemic chemotherapy with XELOX+BV was performed for the residual tumor. On the 27th day after the first administration of BV, the patient was hospitalized because of anal bleeding and a state of shock. The colonoscopic examination showed a dimple caused by tumor shrinkage, which was closed by clipping. However, a state of shock was caused by intermittent hemorrhages again afterwards. The hemorrhagic point was identified as the oral side of the dimple by angiography, and coil embolization led to immediate hemostasis. The colonoscopic examination revealed nothing abnormal besides the dimple. It is therefore suspected that the cause of rectal hemorrhage might be induced by BV. During combination chemotherapy with BV, bleeding is one of the severe adverse events requiring an emergent treatment regardless of BV dose. IVR may be an effective treatment when bleeding can not be controlled by endoscopic hemostasis. Therefore, we should construct a system for emergency hemostasis including IVR.
authors.affiliation: Dept. of Surgery, Kanagawa Prefectural Ashigara-Kami Hospital.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Tsuchida
authors.forename: Yui
authors.initials: Y
authors.lastname: Honjoh
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asari
authors.forename: Etsuko
authors.initials: E
authors.lastname: Osawa
authors.forename: Koji
authors.initials: K
authors.lastname: Numata
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yoshida
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Osaragi
authors.forename: Katsuya
authors.initials: K
authors.lastname: Yoneyama
authors.forename: Akio
authors.initials: A
authors.lastname: Kasahara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shibuya
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takizawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Miura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yoshie
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
mesh_terms: D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D000069287:Capecitabine; D059248:Chemoradiotherapy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000601:surgery; D006801:Humans; D008297:Male; D010071:Oxaloacetates; D012004:Rectal Neoplasms / Q000628:therapy*; D012008:Recurrence
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D010071:Oxaloacetates; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D005472:Fluorouracil