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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




Journal article


BMJ case reports

Publication Date





Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK


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