Antineoplastics
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Antineoplastics Biliary tract necrosis: case report A 35-year-old man, with Hodgkin's lymphoma of the skeleton, initially received doxorubicin, cyclophosphamide , vincristine, bleomycin and prednisone. Radiotherapy was initiated after 2 months because of tumour progression in the vertebral column. Chemotherapy was changed to doxorubicin , vincristine, bleomycin and dacarbazine. After a further 1.5 months the total dose of doxorubicin administered was 145mg. The following month, the drug regimen was changed to vinblastine, chlorambucil, procarbazine and prednisone. After about 0.5 months' therapy with the thi rd regimen (6 .5 months after diagnos is) , the patient presented with acute left side abdominal pain, then pneumonia, and septicaemia with disseminated intravascular coagulation Laparotomy revealed dark green discolouratlon of the common bile duct, the fundus of the gallbladder and pericholedochal tissue. The common hepatic duct was thickened but appeared otherwise normal. Slight oedema of the duodenum and Jejunum was observed but the' li ver and pancreas appeared normal. The common bile duct and gallbladder were removed and a hepaticojejunostomy was performed. Complete non-liquifying necrosis of the common bile duct was found on microscopy with no evidence of inflammation or tumour. Non-necrotic tumour foci were found in the gallbladder wall. Following surgery the patient improved briefly then deteriorated. Second laparotomy revealed a non-infective cyst beneath the hepaticojejunostomy, which was reconstructed. Later, biliary and duodenal fistulae appeared and the patient progressively deteriorated, then died. Autopsy revealed necrotic tissue retroperitoneally and in the hepatoduodenal ligament. The fistulae opened in this area and 2 liver abcesses were found . Enlarged fibroblasts were found around the necrotic bile duct but the intrahepatic bile ducts were normal. Necrosis in the mucosa of the common bile duct , probably as a result of exposure to radiation and concomitant exposure to doxorubicin, would have resulted in the leakage of bile and doxorubicin through the duct wall, resulting in further necrosis and predisposing to septicaemia. The localised necrosis found in this patient ' ... could have been caused by the combined effect of radiotherapy and cytotoxic drugs , probably doxorubicin '. Wlig IN , Telhaug R, 0degaard A, Saether 0 Ac ta Chlfurglca Scandinavia 153 701 ·703 . Nov· Dec 1987 63<3 0157-7271 / 88/ 0409-0005/ 0$01 .00/ 0 © ADIS Press REACTIONS' 9 April 1988 5
Transcript of Antineoplastics
Antineoplastics Biliary tract necrosis: case report
A 35-year-old man, with Hodgkin 's lymphoma of the skeleton , initially received doxorubicin , cyclophosphamide , vincristine , bleomycin and prednisone .
Radiotherapy was initiated after 2 months because of tumour progression in the vertebral column . Chemotherapy was changed to doxorubicin , vincristine , bleomycin and dacarbazine. After a further 1.5 months the total dose of doxorubicin administered was 145mg. The following month , the drug regimen was changed to vinblastine, chlorambucil , procarbazine and prednisone.
After about 0.5 months' therapy with the thi rd regimen (6.5 months after diagnosis), the patient presented with acute left side abdominal pain , then pneumonia, and septicaemia with disseminated intravascular coagulation Laparotomy revealed dark green discolouratlon of the common bile duct , the fundus of the gallbladder and pericholedochal tissue. The common hepatic duct was thickened but appeared otherwise normal. Slight oedema of the duodenum and Jejunum was observed but the' liver and pancreas appeared normal . The common bile duct and gallbladder were removed and a hepaticojejunostomy was performed . Complete non-liquifying necrosis of the common bile duct was found on microscopy with no evidence of inflammation or tumour. Non-necrotic tumour foci were found in the gallbladder wall. Following surgery the patient improved briefly then deteriorated . Second laparotomy revealed a non-infective cyst beneath the hepaticojejunostomy, which was reconstructed. Later , biliary and duodenal fistulae appeared and the patient progressively deteriorated, then died. Autopsy revealed necrotic tissue retroperitoneally and in the hepatoduodenal ligament. The fistulae opened in this area and 2 liver abcesses were found . Enlarged fibroblasts were found around the necrotic bile duct but the intrahepatic bile ducts were normal.
Necrosis in the mucosa of the common bile duct, probably as a result of exposure to radiat ion and concomitant exposure to doxorubicin , would have resulted in the leakage of bile and doxorubicin through the duct wall , resulting in further necrosis and predisposing to septicaemia. The localised necrosis found in this patient ' ... could have been caused by the combined effect of radiotherapy and cytotoxic drugs , probably doxorubicin '. Wlig IN, Telhaug R, 0degaard A, Saether 0 Acta Chlfurglca Scandinavia 153 701 ·703. Nov· Dec 1987 63<3
0157-7271 / 88/ 0409-0005/ 0$01 .00/ 0 © ADIS Press REACTIONS' 9 April 1988 5
