Small Bowel Perforation Caused by Tumor Lysis after Chemotherapy for Primary Peritoneal Carcinoma

Abstract

Background: Primary peritoneal carcinoma (PPC) is a rare malignancy, which is closely related to ovarian cancer. Surgical debulking and chemotherapy are the hallmarks of therapy; the malignancy has an acceptable prognosis. Case Presentation: A 70-year-old female with known metastatic PPC presented to the emergency department with acute abdomen six days after chemotherapy. Computed tomography (CT) revealed substantial amounts of free air. During emergency exploratory laparotomy, peritoneal carcinomatosis was found and the source of the peritonitis was identified as a leak in the small bowel at an area of tumor necrosis. The ulcerated perforated area was excised and primarily closed in two layers; mobilization of the small bowel for an anastomosis was not possible technically because of the mesenteric tumor infiltration. The patient was discharged after 10 d and chemotherapy was re-started. She died five months later from tumor progression. Discussion: Surgeons may become involved in managing patients with PPC if complications such as bowel obstruction or perforation develop. Bowel perforation caused by tumor lysis of intra-mural metastases has been described for several types of cancer, however, to the best of our knowledge, this is the first such case reported for metastatic PPC.