Pneumatosis Intestinalis After Molecular-Targeted Therapy

Area of Science:

• Oncology
• Gastroenterology
• Radiology

Background:

• Pneumoperitoneum typically indicates bowel perforation after abdominal surgery.
• Rarely, molecular-targeted therapies (MTTs) can cause pneumatosis intestinalis or pneumoperitoneum in cancer patients.
• This phenomenon is observed without typical perforation indicators.

Observation:

• A 67-year-old male with multiple malignancies received bevacizumab for cerebellar subependymoma recurrence.
• Following ventriculoperitoneal shunt placement, the patient developed pneumomediastinum and pneumoperitoneum.
• Laparoscopy revealed focal sigmoid pneumatosis without perforation or ischemia.

Findings:

• Bevacizumab was discontinued, leading to improvement in the patient's clinical and radiologic findings.
• Pneumatosis intestinalis and pneumoperitoneum can be adverse effects of bevacizumab.
• Discontinuation of MTTs often resolves these findings.

Implications:

• Molecular-targeted therapies, including bevacizumab, should be considered as potential causes of pneumoperitoneum in neurosurgical patients.
• While bowel perforation must be ruled out, alternative etiologies like bevacizumab warrant consideration.
• MTT-associated pneumatosis intestinalis may present with benign physical exams and resolve upon drug cessation.