Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2020; 12(11): 1364-1371
Published online Nov 15, 2020. doi: 10.4251/wjgo.v12.i11.1364
Inferior mesenteric arteriovenous fistula during treatment with bevacizumab in colorectal cancer patient: A case report
Ayako Doi, Hiroyuki Takeda, Kumiko Umemoto, Ryosuke Oumi, Shinji Wada, Shingo Hamaguchi, Hidefumi Mimura, Hiroyuki Arai, Yoshiki Horie, Takuro Mizukami, Naoki Izawa, Takashi Ogura, Takako Eguchi Nakajima, Yu Sunakawa
Ayako Doi, Hiroyuki Takeda, Kumiko Umemoto, Hiroyuki Arai, Yoshiki Horie, Takuro Mizukami, Naoki Izawa, Takashi Ogura, Yu Sunakawa, Department of Clinical Oncology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
Ryosuke Oumi, Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
Shinji Wada, Shingo Hamaguchi, Hidefumi Mimura, Department of Radiology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
Takako Eguchi Nakajima, Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto 606-8507, Japan
Author contributions: Doi A was the patient’s medical oncologist, reviewed the literature, and contributed to manuscript drafting; Takeda H, Umemoto K, Arai H, Horie Y, MizukamiI T, Izawa N, Ogura T, Nakajima TE, and Sunakawa Y reviewed the literature and contributed to manuscript drafting; Oumi R was the gastroenterology disease consultation, reviewed the literature, and drafted the manuscript; Wada S, Hamaguchi S, and Mimura H interpreted the imaging findings and contributed to manuscript drafting; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors have declared no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu Sunakawa, PhD, Associate Professor, Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan. y.sunakawa@marianna-u.ac.jp
Received: June 24, 2020
Peer-review started: June 24, 2020
First decision: August 9, 2020
Revised: August 20, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: November 15, 2020
Abstract
BACKGROUND

Fistula formation is a severe adverse event related to antiangiogenetic agents such as bevacizumab and inferior mesenteric arteriovenous fistula (IMAVF) is a result of acquired factor, especially colon surgery. However, IMAVF occurs very rarely and there are few reports in patients during chemotherapy. We report a case of a patient who developed IMAVF during treatment with bevacizumab in metastatic colorectal cancer (mCRC) after colon surgery.

CASE SUMMARY

An 81-year-old man was diagnosed with descending colon cancer and underwent left hemicolectomy without any complications. He was definitely diagnosed with high-risk stage 2 and received tegafur-uracil plus leucovorin as adjuvant chemotherapy. Three years and 6 mo after the operation, the cancer relapsed with peritoneal dissemination. The patient underwent CyberKnife radiosurgery targeting the recurrent tumor and received chemotherapy with S-1 plus bevacizumab. At 1 year after chemotherapy, he complained of severe diarrhea, which is suspected drug-induced colitis. As diarrhea worsened despite the termination of treatment, he underwent colonoscopy and computed tomography (CT) scans that revealed edematous change from sigmoid to rectosigmoid colon. CT scans also revealed an aneurysm adjacent to the inferior mesenteric vein and multidetector CT angiography showed the IMAVF. Elective angiography confirmed the diagnosis of an IMAVF and it was successfully treated by arterial embolization. The patient resumed chemotherapy with only S-1 6 mo after embolization.

CONCLUSION

Clinicians should keep in mind the probability of severe diarrhea arose from IMAVF in mCRC patients treated with bevacizumab.

Keywords: Metastatic cancer, Colon surgery, Chemotherapy, Fistula formation, Inferior mesenteric artery, Interventional radiology, Case report

Core Tip: Gastrointestinal perforation and fistula formation are s bevacizumab-induced serious adverse events (SAEs). Arteriovenous fistula may occur during bevacizumab treatment via the action of antiangiogenetic agent. Inferior mesenteric arteriovenous fistula (IMAVF) arises from acquired factors especially colon surgery, although there has been no report related to chemotherapy including bevacizumab. We report a case of IMAVF in metastatic colorectal cancer (mCRC) during bevacizumab treatment. This patient complained of severe diarrhea caused by ischemic colitis due to IMAVF. As fistula may be lethal complications, clinicians should pay attention to SAEs including IMAVF for mCRC patients during bevacizumab treatment.