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      Pneumatosis cystoides intestinalis linked to sunitinib treatment for renal cell carcinoma

      case-report

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          Abstract

          Introduction

          Pneumatosis cystoides intestinalis is a rare condition characterized by air‐filled cysts within intestinal walls. It can be caused by various factors. We report a case of pneumatosis cystoides intestinalis linked to sunitinib treatment for renal cell carcinoma.

          Case presentation

          A 67‐year‐old female with advanced renal cell carcinoma who had been treated with sunitinib visited our hospital complaining of abdominal pain. Computed tomography scans showed diffuse air‐filled cystic formation of intestine. We treated with conservative therapy, and she recovered. However, although air‐filled cysts disappeared in the images, intraoperative findings in the resection of a recurrent paracaval lymph node showed a thinning of the intestine.

          Conclusion

          It is necessary to consider pneumatosis cystoides intestinalis when a patient using a tyrosine kinase inhibitor complains of abdominal symptoms. It should also be noted that the effect of pneumatosis cystoides intestinalis may remain even if pneumatosis disappears from the image on tomography scans.

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          Most cited references11

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          The spectrum of pneumatosis intestinalis.

          A review of the spectrum of illness associated with pneumatosis intestinalis enables us to identify the probable causes of, the best diagnostic approaches to, and the most appropriate treatments for this condition. A review of all published material in the English language regarding pneumatosis intestinalis was conducted using the PubMed and MEDLINE databases. Any relevant work referenced in those articles and not previously found or published before the limit of the search engine was also retrieved and reviewed. There were no exclusion criteria for published information relevant to the topic. All of the studies cited in the present review make a point that contributes to the portrayal of this condition. In circumstances in which the same point was made in several different studies, not all were cited herein. All published material on pneumatosis intestinalis was considered. Information was extracted for preferentially selected ideas and theories supported in multiple studies. The collected information was organized by theory. Mucosal integrity, intraluminal pressure, bacterial flora, and intraluminal gas all interact in the formation of pneumatosis intestinalis. Radiography and computed tomography are the best diagnostic tests. Nonoperative management should be pursued in most patients, and underlying illnesses should be treated. When acute complications appear, such as perforation, peritonitis, and necrotic bowel, surgery is indicated.
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            Gastrointestinal perforation due to bevacizumab in colorectal cancer.

            Bevacizumab is the first U.S. Food and Drug Association-approved vascular endothelial growth factor-targeted agent that greatly increases progression-free and overall survival in combination with standard chemotherapy regimens in patients with metastatic colorectal cancer. Although bevacizumab is generally well tolerated, some serious adverse events have occurred in some patients in clinical trials, including arterial thromboembolism and gastrointestinal (GI) perforation. GI perforation was first observed in the pivotal phase 3 trial, in which six events occurred in bevacizumab group (1.5%), compared with no events in the control group. Since then, similar rates of GI perforation have been observed in other large trials. Typical presentation was abdominal pain associated with constipation and vomiting. Such events occurred throughout treatment and were not correlated with duration of exposure. No difference in rate of GI perforations was found in patients who did and did not have a baseline history of peptic ulcer disease, diverticulosis, and history of chronic use of nonsteroidal anti-inflammatory drugs. However, the incidence of GI perforation seemed to be higher in patients with primary tumor intact, recent history of sigmoidoscopy or colonoscopy, or previous adjuvant radiotherapy, but it is necessary to confirm these preliminary findings by multivariate analyses. The mechanism responsible for causing GI perforation is not known and may be multifactorial. Bevacizumab should be permanently discontinued in patients who develop GI perforation. This article reviews the incidence, presentation, pathogenesis, risk factors, and management of GI perforation in patients with colorectal cancer who are treated with bevacizumab.
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              Pneumatosis intestinalis and bowel perforation associated with molecular targeted therapy: an emerging problem and the role of radiologists in its management.

              The purpose of this article is to study the imaging features, management, and outcome of pneumatosis intestinalis and bowel perforation associated with molecular targeted therapy.
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                Author and article information

                Contributors
                inosyogo@hiroshima-u.ac.jp
                Journal
                IJU Case Rep
                IJU Case Rep
                10.1002/(ISSN)2577-171X
                IJU5
                IJU Case Reports
                John Wiley and Sons Inc. (Hoboken )
                2577-171X
                17 September 2019
                November 2019
                : 2
                : 6 ( doiID: 10.1111/iju5.v2.6 )
                : 318-320
                Affiliations
                [ 1 ] Department of Urology Hiroshima University Hospital Hiroshima Japan
                Author notes
                [*] [* ] Correspondence: Shogo Inoue M.D., Ph.D., Department of Urology, Hiroshima University Institute of Biomedical and Health Sciences, 1‐2‐3 Kasumi, Minami‐ku, Hiroshima City, Hiroshima 734‐8551, Japan. Email: inosyogo@ 123456hiroshima-u.ac.jp
                Author information
                https://orcid.org/0000-0003-4981-0074
                https://orcid.org/0000-0002-4152-0569
                https://orcid.org/0000-0003-1525-5463
                Article
                IJU512119
                10.1002/iju5.12119
                7292122
                32743449
                329735ab-6fec-4cca-aa2a-555249bf4c46
                © 2019 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 April 2019
                : 09 August 2019
                Page count
                Figures: 2, Tables: 1, Pages: 3, Words: 2087
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                November 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:08.06.2020

                operation,pneumatosis cystoides intestinalis,sunitinib

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