Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis. Issue 4 (26th April 2022)

• Record Type: Journal Article
• Authors: Bhadbhade, Megha; Connolly, Elizabeth; Badiani, Sarit; Yeo, David; Bhadri, Vivek
• Is Part Of: BMJ case reports. Volume 15:Issue 4(2022)
• Publication Date: 2022-04-26
• Subjects: Chemotherapy -- Malignant disease and immunosuppression -- Surgical oncology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-247774
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Osteosarcoma is the most common paediatric and adolescent primary bone malignancy and is highly chemosensitive. Gastrointestinal metastases from osteosarcomas are rare. Bowel perforation secondary to chemotherapy is a potential serious complication reported in ovarian, colorectal and haematological malignancies. We report the first documented case of chemotherapy-mediated bowel perforation in an osteosarcoma patient with gastrointestinal metastases. A man in his 20s, with a history of resected osteosarcoma in remission, presented with abdominal pain. A computed tomography (CT) scan demonstrated a large calcified intrabdominal mass (15×13×9 cm) consistent with new peritoneal disease. After one cycle of palliative ifosfamide and etoposide chemotherapy, he developed a large bowel perforation and neutropenic sepsis consequently requiring resection of the perforated mass. Chemotherapy-induced bowel perforation is a rare but serious complication that should be considered in patients with osteosarcoma, and other chemosensitive malignancies, with intra-abdominal metastases. Recommencement of systemic therapies after bowel complications must be assessed cautiously on a case-by-case basis.