Pneumatosis intestinalis after etoposide-based chemotherapy in a patient with metastatic small cell lung cancer: successful conservative management of a rare condition

Abstract

A 69-year-old male patient, smoker, was diagnosed with small cell lung cancer metastatic to lung, liver and central nervous system. He received chemotherapy with carboplatin AUC 5 on day 1 and etoposide 100mg/m2 on days 1, 2 and 3. During the first cycle, the patient presented with febrile neutropenia and abdominal distension. Chest, abdomen and pelvis computed tomography scan was performed and detected gas dissecting the wall of sigmoid colon extending to the mesosigmoid. Patient had no abdominal pain, nausea, vomiting, and on physical examination he had no peritoneal irritation, tachycardia or hemodynamic instability compatible with perforation or acute abdomen. Therefore, the radiological finding was interpreted as pneumatosis intestinalis caused by chemotherapy with etoposide. Pneumatosis resolved after continuous oxygen therapy. The second cycle was administered after a complete resolution of the clinical condition and etoposide dose was reduced by 30%. The patient experienced a remarkable evolution.

Pneumatosis Intestinalis following Radiation Esophagitis during Chemoradiotherapy for Lung Cancer: A Case Report

“…From these observations, it was considered that the PI developed via the entry of gas from the mucosal injury of the esophagus into the submucosa, and gas spread to the stomach and intestinal tract after increased intraluminal pressure due to vomiting. Moreover, as previous reports show [ 8 , 11 , 12 ], febrile neutropenia and chemotherapy would also contribute to the development of pneumatosis.…”

“…In addition, the pulmonary theory explains the mechanism of PI onset. This theory explains that the mechanism by which pulmonary disease causes PI is the gas released via the rupture of alveoli, which moves through the mediastinum and retroperitoneum into the intestinal wall [ 8 ]. However, in our case, no pneumatosis was observed in the lungs, mediastinum, or mesentery.…”

“…Three reports have shown the development of PI in patients with esophageal cancer during chemoradiotherapy (CRT) [ 5 , 6 , 7 ]. However, in lung cancer, there have been several reports of PI development during treatment with cytotoxic chemotherapy agents or epidermal growth factor receptor tyrosine kinase inhibitors [ 8 , 9 ]. Herein, we present the first case of PI following radiation-induced esophagitis during CRT for lung cancer.…”

Pneumatosis cystoides intestinalis associated with etoposide in hematological malignancies: a case report and a literature review

“…Six cases of PCI/PI associated with etoposide are described in Table 2 [ 29 , 32 , 34 , 35 ]. Details including sex, age, underlying diseases, chemotherapy, causative agent, location, associated symptoms, diagnostic tool, treatments, outcome and time to recovery, were collected.…”

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

“…Among adult patients, secondary PI is mainly associated with gastrointestinal disease, pulmonary diseases, mechanical ventilation, endoscopic procedures, infections and other immunological conditions [ 8 ]. Medications used for cancer treatment are among the most recognized causes of PI, including cytotoxic chemotherapeutic agents [ 9 ] and molecular targeted agents [ 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 ].…”