[Chemotherapy-associated enterocolitis--a rare but potentially lethal side effect of adjuvant breast cancer treatment: a case report].

Abstract

ANAMNESIS:

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.

FINDINGS:

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.

DIAGNOSIS:

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

THERAPY AND COURSE:

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.

CONCLUSION:

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.

• Authors: J W Janni, E Klanner, B Rack, H Sommer, K Friese
• Journal: Gynakologisch-geburtshilfliche Rundschau (Gynakol Geburtshilfliche Rundsch) Vol. 44 Issue 4 Pg. 240-3 (Oct 2004) ISSN: 1018-8843 [Print] Switzerland
• Vernacular Title: Chemotherapieassoziierte Enterokolitis--Eine seltene, aber potenziell letal verlaufende Nebenwirkung bei der adjuvanten Behandlung des Mammakarzinoms. Ein Fallbericht.
• PMID: 15459523 (Publication Type: Case Reports, Journal Article)

Chemical References

• Taxoids
• Docetaxel
• Epirubicin
• Cyclophosphamide

Topics

• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, toxicity)
• Breast Neoplasms (drug therapy, pathology, surgery)
• Chemotherapy, Adjuvant (adverse effects)
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage, toxicity)
• Docetaxel
• Drug Administration Schedule
• Enterocolitis, Necrotizing (chemically induced, diagnosis)
• Epirubicin (administration & dosage, toxicity)
• Fatal Outcome
• Female
• Humans
• Intestinal Pseudo-Obstruction (chemically induced, diagnosis, surgery)
• Mastectomy, Segmental
• Middle Aged
• Neoplasm Staging
• Reoperation
• Taxoids (administration & dosage, toxicity)
• Treatment Failure