Radiologic findings in taxane-induced colitis

Kaur, Harjeet; Loyer, Evelyne M.; Sawaf, Hassan; DuBrow, Ronelle A.; Ibrahim, NK

doi:10.1016/j.clinimag.2008.06.016

Cited by 2 publications

(3 citation statements)

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“…Colitis is a rare but potentially severe consequence of taxane-based chemotherapy. In the last decade, taxane colitis has been recognized as a clinical entity marked by abdominal pain with rebound tenderness that may or may not be accompanied by neutropenic fever or diarrhea [1], which can be complicated by perforation and even death. Immediate identification of this condition is critical for timely and aggressive management, which includes vigorous fluid resuscitation, antibiotics, and surgical consultation.…”

Section: Discussionmentioning

confidence: 99%

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Collateral Damage: Taxane-Induced Colonic Perforation

Erdrich¹,

Kastenberg²,

DiMaio³

et al. 2014

Dig Dis Sci

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A 70-year-old woman with history of multifocal right breast cancer (ER-/PR-/Her2neu?) was evaluated in the emergency department for acute abdominal pain. Her past medical history was notable for well-controlled asthma and pulmonary sarcoidosis treated with prednisone 6 years earlier. She had no significant surgical history. Three days prior to initial evaluation she had completed the fifth of six planned cycles of neoadjuvant chemotherapy with docetaxel, carboplatin, and trastuzumab. She recalled mild cramping pain after the last few cycles that was sometimes associated with diarrhea but had always self-resolved. The fifth cycle was followed by more severe and progressive pain.She arrived to the emergency department afebrile with normal vital signs. Her abdomen was firm and diffusely tender with rebound in the left lower quadrant. Although her WBC count was 8.4 9 10 9 /L with 70 % neutrophils, she had received pegfilgrastim that week. Lactate and electrolytes were normal. A computed tomography scan was interpreted as showing free intraperitoneal air and fluid in addition to peritoneal enhancement, thickening of the small bowel, and thickening from the distal transverse through the sigmoid colon. A 3-cm fluid collection was identified adjacent to the sigmoid. Additionally, free fluid was visualized near the duodenum (Fig. 1). The site of enteric perforation was not apparent.Based on her examination and imaging, she was brought to the operating room directly from the emergency department for exploratory laparotomy, during which peritonitis was identified with a purulent exudate in the right upper quadrant including the perihepatic and pericholecystic spaces with intact duodenum and stomach. Extensive pus was found in the pouch of Douglas surrounding a focally necrotic, free and well-circumscribed perforation on the anti-mesenteric surface of the sigmoid colon, remote from perforating blood vessels or the sparse diverticula present (Fig. 2), confirmed intraoperatively. A sigmoid resection with end colostomy was performed to enable the resumption of chemotherapy.Her postoperative course was unremarkable, with early return of bowel function and rapid toleration of a regular diet. She was treated with piperacillin/tazobactam while inpatient and discharged to home on the fifth postoperative day with amoxicillin/clavulanic acid in order to complete a total antibiotic course of 10 days for the intraabdominal perforation and extensive purulence. Gross and histopathologic examination of the surgical specimen backed by a detailed operative report conclusively excluded a ruptured diverticulum as the cause of perforation. Since striking mitotic arrest was present in the enteric epithelium with numerous mitotic spindles arranged in ring forms (Fig. 3), taxane-related enteric perforation was diagnosed.Trastuzumab without docetaxel or carboplatin was given for her breast cancer, given the previous consequences of taxane toxicity. Six weeks following perforation, she underwent wire localized lumpectomy and sentinel node biopsy, wh...

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Section: Discussionmentioning

confidence: 99%

“…In a retrospective study of 64 breast cancer patients on taxane chemotherapy hospitalized for gastrointestinal complications, computed tomographic abnormalities were identified in 12 of 41 imaged patients [1]. Imaging findings were non-diagnostic with colonic involvement varying from segmental colitis to pancolitis.…”

Section: Discussionmentioning

confidence: 99%

Collateral Damage: Taxane-Induced Colonic Perforation

Erdrich¹,

Kastenberg²,

DiMaio³

et al. 2014

Dig Dis Sci

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show abstract

“…CT scan of abdomen and pelvis may reveal involvement of any segment of the bowel or pan colitis as well as BWT, peritoneal stranding, and/or ascites. 10 The cecum may not be involved, as is almost always the case in patients with neutropenic enterocolitis. Histological analysis of a biopsied sample typically reveals ischemic features.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Chemotherapy–Induced Colitis

Barcenas¹,

Ibrahim²

2012

Colitis

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Radiologic findings in taxane-induced colitis

Cited by 2 publications

References 0 publications

Collateral Damage: Taxane-Induced Colonic Perforation

Collateral Damage: Taxane-Induced Colonic Perforation

Chemotherapy–Induced Colitis

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