Pneumatosis Cystoides Intestinalis Secondary to Sunitinib Treatment for Gastrointestinal Stromal Tumor

Abstract

A 67-year-old man with liver and retroperitoneal metastases from a gastrointestinal stromal tumor arising in the jejunum had been administered oral sunitinib for 2 months. He presented to our department with right-sided lower abdominal pain. His general condition was good, with no high-grade fever, and the other vital signs were also stable. Contrast-enhanced computed tomography was promptly performed, and pneumatosis cystoides intestinalis (PCI) was detected in a wide area around the ileocecal lesion. There were no signs of acute abdomen requiring emergency surgery due to conditions such as intestinal perforation, ischemia, or obstruction. Sunitinib was discontinued and the patient was placed on nil orally with intravenous infusion. PCI resolved promptly and the patient was discharged on the 21st day after admission. PCI is a rare side effect of sunitinib with only 8 cases reported previously, which can complicate with acute abdomen or gastrointestinal perforation, in some cases. Thus, the early identification of sunitinib as the cause of PCI is important. Although PCI is a rare adverse effect of sunitinib, clinicians must be aware of it to promptly provide the correct diagnosis and treatment.

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

“…All titles were screened, after which 65 full-text articles were assessed for eligibility. Ultimately, 50 records that met our eligibility criteria were identified, and 12 more reports were retrieved through reference mining, reaching a total of 62 articles that were included in our systematic review ( Figure 2 ) [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 62 , 64 , 65 , 67 , 68 , 69 , ...…”

Pneumatosis cystoides intestinalis induced by sunitinib therapy in a patient with metastatic renal cell carcinoma: A case report

“…Furthermore, TKIs can affect the microvasculature of the gastrointestinal tract, [15] leading to mucosal ischemia and subsequent gas accumulation in the submucosal or subserosal Only a few cases of PCI caused by TKIs have been reported in the literature, with the majority recovering after conservative treatment. [8,16,17] Only 2 cases have been reported wherein intra-abdominal findings were confirmed surgically. In 1 patient, after conservative treatment, thinning of the intestine was observed during the resection of a recurrent paracaval lymph node, [17] while in the other, there was perforation of the jejunum.…”

“Cystamatic” Review: Is Surgery Mandatory for Pneumatosis Cystoides Intestinalis?

“…The principal symptom was abdominal pain associated with the finding of free air under diaphragm. These [12] 65 years, M Secondary Intake of α-glucosidase inhibitors Takahashi et al [13] 17 years, F Idiopathic -Singh et al [14] N/A, F Secondary Systemic sclerosis Asahi et al [15] 67 years, M Secondary Neoplasm Uruga et al [16] 71 years, F Secondary Neoplasm Koysombat et al [17] N/A Secondary Systemic sclerosis Wang et al [18] 56 years, M Idiopathic -48 years, F Secondary Exposing to trichloroethylene 66 years, F Secondary Disease of immune system 72 years, F Secondary Diabetes 64 years, M Secondary Emphysema 24 years, F Secondary Neoplasm Martin-Lagos et al [19] 72 years, M Secondary Chemotherapy Suda et al [20] 80 years, M Idiopathic -Márquez Argente et al [21] 48 years, M Idiopathic de la Serna et al [22] 83 years, M Secondary Chemotherapy Mikami et al [23] 72 years, M Secondary Ulcerative colitis Sugihara et al [24] 48 years, F Secondary Therapy with glucocorticoid Kunishi et al [25] 84 years, M Secondary Intake of α-glucosidase inhibitors Lee et al [26] 68 years, F Secondary Chemotherapy Kang et al [27] 54 years, M Secondary COPD Nakatani et al [28] 70 years, M Secondary Granulomatosis with polyangiitis Rachapalli et al [29] 50 years, M Secondary Neoplasm Jegadeesan et al [30] 51 years, M Secondary Neoplasm Liao et al [31] 84 years, F Idiopathic -Suzuki et al [32] 71 years, F Secondary Connective tissue disease 70 years, F Secondary Connective tissue disease 70 years, M Secondary Connective tissue disease 42 years, F Secondary Connective tissue disease Iida et al [33] 79 years, M Secondary COPD Romano-Munive et al [34] 54 years, F Idiopathic -Venkataramani et al [35] 56 years, F Secondary Neoplasm Faria et al [36] 69 years, M Secondary Neoplasm Fujimi et al [37] 55 years, M Secondary Interstitial pneumonia with corticosteroid therapy Furihata et al [38] 81 years, M Idiopathic -Mima et al [39] 46 years, M Secondary Rheumatoid arthritis Torigoe et al [40] 77 ...…”