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[Intestinal pneumatosis and pneumoperitonum: not always a surgical indication]
Julio César Rotondaro1, Manuel Maya2, Magalí Gutierrez1
1Servicio de Unidad de Cuidados Especiales, Sanatorio Mater Dei, Buenos Aires, Argentina.
Medicina
|June 22, 2024
Summary
Pneumatosis intestinalis and pneumoperitoneum, often signs of serious abdominal issues, resolved spontaneously in a stage IV breast cancer patient. This case suggests a potential link to ribociclib, a chemotherapy drug, warranting further investigation.
Area of Science:
- Oncology
- Gastroenterology
- Radiology
Background:
- Pneumatosis intestinalis and pneumoperitoneum are radiological signs, not diseases, typically indicating severe intra-abdominal conditions requiring surgery.
- These signs are often linked to bowel resection due to ischemia or perforation.
Observation:
- An 80-year-old woman with stage IV breast cancer on fulvestrant and ribociclib presented with abdominal pain and vomiting.
- Radiological imaging revealed pneumatosis intestinalis and pneumoperitoneum, leading to an exploratory laparotomy.
- No intestinal necrosis or perforation was found, and surgical intervention was avoided.
Findings:
- The patient's condition resolved spontaneously during hospitalization, with complete radiological resolution one month post-discharge.
- While associated with increased intra-abdominal pressure and neoplasms, pneumatosis intestinalis has not been previously reported with ribociclib in humans.
- The etiology is likely multifactorial, possibly involving ribociclib's indirect effects (vomiting, immunosuppression) or direct enterocyte toxicity.
Implications:
- This case highlights a potential, previously unreported association between ribociclib and pneumatosis intestinalis/pneumoperitoneum.
- Further research is needed to elucidate the mechanisms and confirm the role of ribociclib in these radiological findings.
- This finding may influence the management of gastrointestinal symptoms in cancer patients receiving similar chemotherapies.
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