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Paweł Dilling, Jakub Walczak, Paweł Pikiel and Wiesław J. Kruszewski

Abstract

Ipilimumab, an anticancer drug, is an anti-CTLA4 monoclonal antibody. It is used in treatment of disseminated melanoma. Therapy is associated with high risk of complications. One of the most serious, although one of the rarest is perforation of gastrointestinal tract. In this case report we describe a 52-year old male, with disseminated melanoma with unknown starting point, treated with anti- CTLA4 monoclonal antibody. After 3rd dose of drug administration, bloody diarrhea and acute abdominal pain occurred as a symptom of gastrointestinal perforation. A single perforation was sutured during laparotomy. Symptoms of acute abdomen returned after 10 days. Pus-faecalperitonitis, symptoms of necro-hemorrhagic colitis and multilocal perforation of the colon were found during relaparotomy. Pancolectomy with end ileostomy was performed. Few hours since relaparotomy pacient died due to multiple organ failure. The purpose of this case report is to draw attention to a risk of multilocal colon perforation in patient treated with ipilumumab.

Open access

Wiesław Kruszewski, Wojciech Jasiński, Mariusz Szajewski, Jarosław Szefel, Krzysztof Kawecki, Maciej Ciesielski, Paweł Pikiel, Paweł Dilling and Cezary Warężak

Protective Stomy as a Complement to Anterior Rectal Resection. Analysis of Authors' Material and Literature Review

Anastomotic leak after anterior rectal resection for cancer is one of the most dangerous complications of the procedure. Protective stomy is a way to avoid life-threatening consequences of this complication. The procedure is still under evaluation.

The aim of the study was to evaluate the usefulness of forming a protective stomy as part of anterior rectal cancer resection on the basis of an analysis of the authors' material.

Material and methods. In 2008 - 2009, we treated 111 patients with rectal cancer. Thirty-two of those patients received preoperative radio(chemo)therapy. Eighty-four patients (76%) underwent resection of the primary tumour. In 20 patients (24%), we performed abdominoperineal or abdominosacral resection; in 6 (7%) cases the Hartmann procedure was used and in 58 (69%) cases anterior rectal resection was performed. In 53 of 58 cases, the resections were assessed as curative and in 5 as palliative. In 18 of 58 (31%) patients, anterior resections were defined as low anterior resections. Twelve (67%) of these patients were subjected to preoperative radio(chemo)therapy. Two of 58 patients, who underwent anterior resection, had been treated by stomy creation before the radical procedure. One of them required neoadjuvant radiotherapy. In the second patient with the stomy, we restored the intestinal continuity during the primary tumour resection. Among the remaining 40 patients, only one underwent protective stomy creation during the resective procedure. This patient did not require preoperative radiotherapy.

Results. We have not found any clinical indications of anastomotic leak in the analysed group of 58 patients subjected to anterior rectal resection for cancer.

Conclusions. Our modest experience reaffirms our conviction that anterior rectal cancer resection does not require routine protective stomy creation, also when low anterior resection follows preoperative radiotherapy.