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A 56-year-old man undergoing immunotherapy treatment for metastatic melanoma presented with sudden onset testicular pain radiating into his abdomen. On examination, the abdomen was generally tender with associated guarding. Imaging revealed a perforation of the small bowel at the site of a metastatic lesion. Histology revealed that this process was non-inflammatory in nature. A diagnosis of small bowel perforation secondary to immunotherapy driven rapid tumour regression was made. The patient was treated with a small bowel resection plus anastomosis and made a full recovery. This case highlights the rare potential side effect of immunotherapy in causing non-inflammatory bowel perforations secondary to rapid tumour regression.

Original publication

DOI

10.1136/bcr-2019-232304

Type

Journal article

Journal

BMJ case reports

Publication Date

02/2020

Volume

13

Addresses

Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK kishen.patel1@nhs.net.

Keywords

Humans, Melanoma, Skin Neoplasms, Neoplasms, Unknown Primary, Intestinal Perforation, Immunotherapy, Middle Aged, Male, Antineoplastic Agents, Immunological, Ipilimumab, Nivolumab