Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2020; 8(9): 1693-1697
Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1693
Colonic perforation in a nasopharyngeal carcinoma patient treated with fluorouracil: A case report
Wei-Jia Lu, Gong Li, Lei Gao
Wei-Jia Lu, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Gong Li, Lei Gao, Department of Radiotherapy, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Author contributions: Lu WJ and Li G wrote the manuscript; Gao L was involved in the patient’s medical care, initiated and supervised the study, and wrote and revised the manuscript; all authors have given final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict 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: Lei Gao, PhD, Doctor, Department of Radiotherapy, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 55, Neihuanxi Road, Panyu District, Guangzhou 510006, Guangdong Province, China. dxcflk@gzucm.edu.cn
Received: December 22, 2019
Peer-review started: December 22, 2019
First decision: April 1, 2020
Revised: April 8, 2020
Accepted: April 15, 2020
Article in press: April 15, 2020
Published online: May 6, 2020
Abstract
BACKGROUND

Nasopharyngeal carcinoma (NPC) is a commonly encountered type of tumor. Fluorouracil (FU) is an effective treatment providing satisfactory oncologic outcomes in nasopharyngeal carcinoma patients. We describe a unique case of colonic perforation in an NPC patient treated with FU. Thus far, only two cases of intestinal perforation associated with FU treatment have been reported. We hope that the analysis of the relationship between the adverse effects of FU and physiological factors will help to reduce the incidence of colonic perforation in patients with nasopharyngeal carcinoma treated with FU.

CASE SUMMARY

A 67-year-old female patient suffered from NPC stage pT3N2M0. She had a history of three surgical procedures: Partial enterectomy, partial sigmoidectomy, and sigmoidostomy. After the administration of 2.75 g FU, a bloody stool appeared and the patient developed abdominal pain. Subsequent examination indicated colitis and intestinal perforation.

CONCLUSION

FU is a commonly used drug in NPC chemotherapy. The most common adverse effect of FU is gastrointestinal reaction, and the colonic perforation found here is thought to be caused by gastrointestinal mucosal injury consequential to the FU treatment. When selecting chemotherapy drugs, their side effects and the physical condition of patients should be considered, particularly in patients with a history of gastrointestinal surgery.

Keywords: Chemotherapy, Nasopharyngeal carcinoma, Fluorouracil, Colonic perforation, Reaction, Case report

Core tip: Intestinal perforation associated with fluorouracil treatment is very rare. The possible reason of the perforation in the case presented here is that the patient has undergone intestinal surgeries, her physical condition was poor, and the use of fluorouracil has damaged the intestinal mucosa. In general, patients with intestinal perforation require an immediate surgical treatment. However, the use of radiotherapy and chemotherapy in patients after intestinal surgery is challenging.