Akutes abdomen nach chemotherapie und bestrahlung eines metastasierten sigmakarzinoms

A 56-year-old patient with carcinoma of the sigma and liver and bone metastases was started on 5-FU and leucovorin chemotherapy after resection of the primary. Radiation of vertebral metastases T10-L1 was performed simultaneously. When admitted to our ICU he presented with signs of acute abdomen and septic shock. Blood count revealed severe pancytopenia. A blood culture grew gram-negative bacilli. CT scan demonstrated massive edema of the small bowel with thickening of the wall up to 1 cm. Mesenteric vessels were well enhanced by intravenous contrast material. 12 days after admission the patient died due to septic multiple organ failure. Edema of the whole small bowel was likely due to fulminant enteritis after chemotherapy and radiation. Ischemic genesis was unlikely. Differentiation between "surgical" and "medical" differential diagnoses is essential because of therapeutic consequences. Toxicity profile of prolonged infusions and weekly applications of 5-FU is favourable compared to the monthly bolus. Simultaneous radiation should be avoided or taken into consideration by dose reduction of 5-FU and omitting leucovorin.