Intestinal perforation during chemotherapeutic treatment of intra-abdominal desmoid tumor in patients with Gardner’s syndrome: report of two cases

Abstract

BackgroundA minority of intra-abdominal desmoid tumors is associated with Gardner’s syndrome in which desmoid tumors become an important cause of morbidity and mortality if they are surgically unresectable.Case presentationHere, we report two cases of intestinal perforation during chemotherapy in patients with Gardner’s syndrome-associated intra-abdominal desmoids. One female and one male patients who developed inoperable desmoids were given the chemotherapeutic regimen of doxorubicin plus dacarbazine, followed by meloxicam. Significant tumor regression was observed clinically. However, intestinal perforation happened in both patients. They were subjected to emergency surgery, follow-up management, and survived up to now.ConclusionsThe doxorubicin plus dacarbazine chemotherapy is an effective treatment for intra-abdominal demoid tumors in patients with Gardner’s syndrome. On the other hand, given severe adverse events might occur, clinicians should pay more attention that tumor quick regression may cause intestinal perforation in which urgent surgical intervention is necessary.

Case of small bowel perforation secondary to nivolumab and ipilimumab related tumour regression

“…We believe that patient’s response to nivolumab and ipilimumab was so drastic that the tumour shrinkage caused by the medications, led to perforation within the small bowel. Similar cases have been described in Gardner’s syndrome, where drastic regression of tumour secondary to chemotherapy have resulted in bowel perforations in multiple patients 9…”

Current Update on Desmoid Fibromatosis

“…Various therapeutic agents including anti-estrogenic drugs (tamoxifen and toremifene), non-steroidal anti-inflammatory drugs (meloxicam, indomethacin, sulindac and celecoxib), cytotoxic chemotherapy (doxorubicin, methotrexate and vinblastine) and tyrosine kinase inhibitors (imatinib, sunitinib, pazopanib, sorafenib, sirolimus) have been reported to be useful for achieving disease stability in DF [4, 21, 55, 67–69]. Given the high toxicity profile of some of these agents, patients should be closely monitored for any potential treatment induced complications [55, 70].…”

Clinicopathological and molecular characteristics of abdominal desmoid tumors in the Chinese population: A single‑center report of 15�cases

“…In the present study, hormonal therapy, NSAIDs and chemotherapy were used alone or in combinations to treat patients with primary or recurrent DTs, but the effect was difficult to evaluate. Potential complications should be carefully considered when systemic therapy is used as, In the present study, two patients experienced gastrointestinal perforation due to chemotherapy (33).…”