title: [A Case of Multiple Bevacizumab-Related Colonic Perforations during Opioid Use].
abstract: We present the case ofa 54-year-old man who had been treated with bevacizumab-containing chemotherapy for a postoperative recurrence of lung cancer for 5 months; he had used opioids for cancer pain in his right lateral chest for 2 months. He was admitted to the hospital because his chest pain had worsened 5 days earlier and he was experiencing a dull pain in his lower abdomen. His condition was recognized as an aggravation of the cancer pain and his opioid dose was increased. He presented with intense abdominal pain 6 days after admission, and we diagnosed gastrointestinal perforations from an abdominal CT scan. Therefore, we undertook an emergency operation. Multiple perforations were seen on the transverse and descending colon; an extensive colectomy and a colostomy were performed. Histopathological findings showed that multiple ulcer perforations and normal mucosa coexisted throughout the resected specimen. Bevacizumab-induced ischemic changes were the suspected cause. When pain control becomes variable during opioid use, conditions such as bevacizumab-related gastrointestinal perforations should be considered, in addition to progression of the cancer pain itself, and the appropriate treatment should be administered.
authors.affiliation: Dept. of Surgery, Kurobe City Hospital.
authors.forename: Toru
authors.initials: T
authors.lastname: Kurata
authors.forename: Naoki
authors.initials: N
authors.lastname: Makita
authors.forename: Shigeta
authors.initials: S
authors.lastname: Hagino
authors.forename: Keiko
authors.initials: K
authors.lastname: Iwata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tsuneda
authors.forename: Masato
authors.initials: M
authors.lastname: Kiriyama
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007416:Intestinal Perforation / Q000139:chemically induced* / Q000601:surgery; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012008:Recurrence
chemical_list: D000701:Analgesics, Opioid; D000068258:Bevacizumab; D010098:Oxycodone