Antineoplastics
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Reactions 1396 - 7 Apr 2012 S Antineoplastics Bleeding from small-bowel ulcers in an elderly patient?: case report A 78-year-old woman developed massive bleeding from multiple small-bowel ulcers following antineoplastic therapy for diffuse large B-cell lymphoma. The woman presented with general fatigue, abdominal discomfort, dysphagia, and a loss of appetite for 1 week. She had a history of systemic treatment with "R-CHOP" for 6 months, consisting of rituximab 375 mg/m 2 on day 0, combined with cyclophosphamide 750 mg/m 2 , vincristine 2mg, and doxorubicin 50 mg/m 2 , each given at day 1, and prednisolone 100mg on days 1-5 [routes not stated]. She had tolerated the medication well and achieved complete cytogenetic remission. A month later, after six cycles of R- CHOP therapy, she reported numerous, loose, maroon- coloured stools. She was in hypovolaemic shock upon presentation, and displayed epigastric tenderness and bright red rectal blood. Laboratory analysis was notable for a haemoglobin level and haematocrit of 4.5 g/dL and 14.6%, respectively. She was treated with crystalloids and a blood transfusion; her initial arterial BP was 80/56 Torr. An abdominal CT scan revealed a collection of high-density fluid from the jejunum to the terminal ileum and caecum. She continued to bleed, requiring multiple transfusions, and experienced a further episode of hypotension. Emergent exploratory surgery showed that the proximal jejunum, ileum, and colon were filled with blood. Enteroscopy revealed a clot surrounded by normal mucosa, approximately 150cm distal to the ligament of Treiz. A segmental, small-bowel resection was performed. The woman recovered well, with no recurrent episodes of bleeding. Upon opening the bowel, numerous ulcerations were apparent on the mucosa. Pathological analysis showed multiple, nonspecific active ulcerations, with sharply demarcated areas of focal erosions forming ulcers on the submucosa, and large-calibre submucosal vessels of the jejunoileum. Findings confirmed a diagnosis of acute, nonspecific ulcerative enteritis of the small intestine [outcome not clearly stated]. Kato K, et al. Massive bleeding from acute multiple nonspecific ulcer of the small intestine after R-CHOP with a diffuse large B-cell lymphoma: A rare case report. American Journal of Case Reports 12: 198-202, 27 Dec 2011 - Japan 803068725 1 Reactions 7 Apr 2012 No. 1396 0114-9954/10/1396-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1396 - 7 Apr 2012
SAntineoplastics
Bleeding from small-bowel ulcers in an elderlypatient?: case report
A 78-year-old woman developed massive bleeding frommultiple small-bowel ulcers following antineoplastictherapy for diffuse large B-cell lymphoma.
The woman presented with general fatigue, abdominaldiscomfort, dysphagia, and a loss of appetite for 1 week.She had a history of systemic treatment with "R-CHOP" for6 months, consisting of rituximab 375 mg/m2 on day 0,combined with cyclophosphamide 750 mg/m2, vincristine2mg, and doxorubicin 50 mg/m2, each given at day 1, andprednisolone 100mg on days 1-5 [routes not stated]. Shehad tolerated the medication well and achieved completecytogenetic remission. A month later, after six cycles of R-CHOP therapy, she reported numerous, loose, maroon-coloured stools. She was in hypovolaemic shock uponpresentation, and displayed epigastric tenderness andbright red rectal blood. Laboratory analysis was notable fora haemoglobin level and haematocrit of 4.5 g/dL and14.6%, respectively. She was treated with crystalloids and ablood transfusion; her initial arterial BP was 80/56 Torr. Anabdominal CT scan revealed a collection of high-densityfluid from the jejunum to the terminal ileum and caecum.She continued to bleed, requiring multiple transfusions,and experienced a further episode of hypotension.Emergent exploratory surgery showed that the proximaljejunum, ileum, and colon were filled with blood.Enteroscopy revealed a clot surrounded by normal mucosa,approximately 150cm distal to the ligament of Treiz.
A segmental, small-bowel resection was performed. Thewoman recovered well, with no recurrent episodes ofbleeding. Upon opening the bowel, numerous ulcerationswere apparent on the mucosa. Pathological analysisshowed multiple, nonspecific active ulcerations, withsharply demarcated areas of focal erosions forming ulcerson the submucosa, and large-calibre submucosal vessels ofthe jejunoileum. Findings confirmed a diagnosis of acute,nonspecific ulcerative enteritis of the small intestine[outcome not clearly stated].Kato K, et al. Massive bleeding from acute multiple nonspecific ulcer of the smallintestine after R-CHOP with a diffuse large B-cell lymphoma: A rare case report.American Journal of Case Reports 12: 198-202, 27 Dec 2011 - Japan 803068725
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Reactions 7 Apr 2012 No. 13960114-9954/10/1396-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
