P0217 - Rare Case of Bowel Perforation After a Dose of Paclitaxel

Parth M. Patel, MD¹, Hassan Zreik, MD², Zarqa Yasin, MD³, Sruthi Ramanan, MD³, Parneet Hari, MD⁴, Bipneet Singh, MD³, Devin Malik, MD³, Merritt Bern, MD^3
1Henry Ford Health System, Boston, MA; ²Henry Ford Health System, Jackson, MI; ³Henry Ford Health, Jackson, MI; ⁴Henry Ford Jackson, Jackson, MI

Introduction: Paclitaxel is an antineoplastic chemotherapeutic agent used to treat various malignancies. The mechanism of action involves interference with microtubules during cell division. Various adverse effects exist, but bowel perforation is a rare complication. The cause is thought to be related to chemotherapy-induced neutropenia and bowel necrosis as a direct effect of the medication. We present a case of bowel perforation soon after administration of the paclitaxel.

Case Description/Methods: A 43-year-old female with a family medical history of breast cancer and personal history of diverticulitis was diagnosed with Grade 3 invasive ductal carcinoma with focal tumor necrosis. She underwent a lumpectomy with sentinel lymph node biopsy of the right breast with adjuvant chemotherapy. In addition, the patient received one dose of paclitaxel and Trastuzumab. Two days after the first dose, the patient presented to the hospital with sudden onset left lower quadrant abdominal pain. The pain began 12 hours prior to the presentation. The abdominal pain was initially attributed to diverticulitis. However, examination showed peritonitis, and cross-sectional imaging revealed peritoneal free air concerning for bowel perforation, prompting emergent exploratory laparotomy and sigmoid colectomy with colonic anastomosis.

Discussion: The patient presented with peritonitis and was found to have sigmoid perforation days after administering paclitaxel. Paclitaxel has rarely been reported to cause bowel perforation. It is thought to happen in the presence of neutropenia due to neutropenic enterocolitis or pre-existing gastrointestinal disease. This patient had a history of diverticulitis, constipation, and IBS. Paclitaxel was changed to another adjuvant chemotherapy which the patient completed. Bowel perforation should be considered in patients who present with abdominal pain after administration of paclitaxel.


Disclosures:


Parth M. Patel, MD¹, Hassan Zreik, MD², Zarqa Yasin, MD³, Sruthi Ramanan, MD³, Parneet Hari, MD⁴, Bipneet Singh, MD³, Devin Malik, MD³, Merritt Bern, MD³. P0217 - Rare Case of Bowel Perforation After a Dose of Paclitaxel, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.