Bevacizumab-Associated Bowel Perforation Causing Evisceration

Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF) and inhibits angiogenesis in solid organ tumors. Its use in conjunction with fluorouracil-based chemotherapy for the management of metastatic colorectal cancer (CRC) has proven effective. There is a known, rare chance of gastrointestinal perforation associated with its use. We present a case of a man in his 70s on bevacizumab for metastatic rectal cancer, who presented to the hospital with small bowel evisceration through perforation at his colostomy site, ostensibly caused by a chronic parastomal hernia and bevacizumab chemotherapy. He required emergent surgery. After undergoing resection of an ischemic segment of small bowel, the perforated segment of his colon, and primary repair of his parastomal hernia, and fashioning of a new end colostomy, he recovered well and left the hospital two weeks later. After discharge from the hospital, he was able to continue with palliative chemotherapy.