Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature

Abstract

Background Capecitabine is a prodrug that is enzymatically converted to its active form, fluorouracil (also called 5-fluorouracil), which is commonly used as adjuvant chemotherapy in colorectal cancer patients. Severe gastrointestinal bleeding induced by capecitabine is rare. Here, we are presenting the first case report of surgery specimen assisted diagnosis of this uncommon condition. Case presentation A 63-year-old Chinese male with a history of colon adenocarcinoma and right hemicolectomy presented with severe lower gastrointestinal bleeding 2 days after finishing capecitabine administration during the first cycle of XELOX adjuvant chemotherapy. Because of the negative findings of active bleeding points by digital subtraction angiography (DSA) or colonoscopy, emergency laparotomy and partial enterectomy were performed. The bloody diarrhea had resolved after surgery and a terminal ileitis was diagnosed after pathological examination of the surgical specimen. Conclusions Terminal ileitis induced by capecitabine is likely to be underreported. It should be considered more often as a cause of severe gastrointestinal bleeding during or after treatment with capecitabine agents. Emergency surgery may achieve satisfactory outcomes if endoscopic hemostasis is ineffective. Highlights of this case 1. Gastrointestinal bleeding following capecitabine treatment in colorectal cancer patients might be life-threatening. 2. Terminal ileitis induced by capecitabine should always be considered in the differential diagnosis of severe gastrointestinal bleeding. 3. Awareness of the risk factors such as deficiency of dihydropyrimidine dehydrogenase, advanced age, or right colectomy may aid in reducing capecitabine-related morbidity. 4. When severe bleeding occurs, emergency surgery may achieve satisfactory outcomes if medical and endoscopic interventions are ineffective.

Capecitabine-Induced Ileitis during Neoadjuvant Pelvic Radio-Chemotherapy for Locally Advanced Rectal Cancer: A Case Report with Literature Review

“…We reported a case of acute ileitis observed in a patient who received a diagnosis of locally advanced rectal cancer and subsequently underwent concomitant RT-CHT with capecitabine. The literature reports a total of eighteen other cases of ileitis induced by capecitabine, which are fully reported in Table 2 [21][22][23][24][25][26][27][28][29][30][31][32][33][34]. No clearly identifiable risk factors have been established.…”

“…Common symptoms of ileitis include severe diarrhea that is unresponsive to loperamide, abdominal pain, and infrequently, fever. Severe bleeding resulting from ileitis has been documented in two cases [29,31]. The use of abdominal computed tomography as a diagnostic modality is valuable in identifying the characteristic edema and distension of the small bowel associated with this specific condition.…”

Clostridium difficile Infection During Palliative Capecitabine Chemotherapy: A Case Report

“…A history of fluorouracil hypersensitivity, severe renal impairment, severe hepatic impairment, dihydropyrimidine dehydrogenase deficiency, or severe leukopenia, neutropenia, or thrombocytopenia are all contraindications. Severe GI adverse effects of capecitabine include enterocolitis and rarely ischaemic colitis, which may require surgical intervention (emergency laparotomy and partial enterectomy) [ 7 , 8 ].…”

Glycan-based scaffolds and nanoparticles as drug delivery system in cancer therapy

“…A folic acid-conjugated CS layer was added for cancer targeting at the same time. The functionalized layer-by-layer (LbL) film had directional 5-FU release and showed greater cytotoxicity toward colon cancer cell lines (78) Capecitabine (CAP) is a prodrug of 5-FU (81). It has a short plasma half-life of <0.85 h, CAP is eliminated rapidly from the body and needs frequent administration (82).…”