Diverticular perforation of terminal ileum associated with chemotherapy for non-small cell lung carcinoma: a case report

Abstract

A 71-year-old man was diagnosed with advanced non-small cell lung carcinoma and treated with chemotherapy developed ileocecal diverticulitis three times over the last 2 months of receiving second-line treatment. During the fourth diverticulitis event, the patient presented with fever and abdominal pain, worsening after 5 days. Abdominal computed tomography showed ascites and intra-abdominal free air, suggesting bowel perforation with acute diffuse peritonitis. We performed emergency surgery; the surgical findings showed diverticulosis with perforated diverticula in the ileocecal region. We performed ileocecal resection, an ileostomy and a mucous fistula of the ascending colon. Histopathological examinations revealed pseudodiverticula at the perforation, where the mucosa was depressed through the muscularis propria. Hence, we diagnosed perforated ileal diverticulitis. Repeated diverticulitis triggered by chemotherapy might have resulted in perforation. Small bowel diverticula are rare, but diverticulitis can occur in patients receiving chemotherapy and with cases of unexplained fever and abdominal pain.

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“…These patients usually complain of abdominal pain, which sometimes radiates in the back, nausea, emesis, fever, and constipation. Due to the greater frequency in the older adult population, where many other health issues or previous surgical history can co-exist, the diagnosis could be challenging [2,5,7,[27][28][29][30][31][32][33][34].…”

“…Due to the rarity of the disease, there are instances in the literature where the diagnosis was not clearly established before the exploratory intervention but only during exploratory laparoscopy. In our cases, the preoperative CT scan was exact for the site and the number of the ill-defined diverticula [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”

“…An annual monitoring protocol, including a clinical examination and CT scan of the abdomen, is necessary in case of accidental detection. Prior history-based clinical suspicion is also important [4,28,35,[44][45][46][47][48][49].…”