Multiple bowel perforations on bevacizumab therapy. Review of the literature and clinical case

Introduction. Biological agents such as bevacizumab with anti-VEGF (vascular endothelial growth factor) alone or in conjunction with chemotherapy increase the risk of bowel perforation. The eLibrary query "bevacizumab" received 202 publications, but no reports of bowel perforation during treatment with this drug were found. Clinical case. Here is a clinical case of surgical treatment of a patient with tumor perforation of the transverse colon, recurrent perforations of the duodenum and jejunum on the background of bevacizumab therapy. Discussion. Bowel perforation due to tumor necrosis and direct damaging effects on the intestinal wall is indicated as a possible complication of bevacizumab therapy. Kidney-cell and generalized colorectal cancer, unresectable primary tumor, therapy with high doses of bevacizumab (5 mg/kg), colonoscopy within 1 month after initiation of therapy, and prior radiation therapy are risk factors for perforation. Conclusions The results of surgery and nonoperative treatment of gastrointestinal perforations against the background of bevacizumab therapy are considered.