Peritonitis Karsinomatozisli(PK) Hastalarda Sitoredüktif Cerrahi ve Hipertermik intraperitoneal kemoterapi (HİPEK) İşlemi sonrası geç dönem jejunal anslarda perforasyon

Öz

Amaç: Sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HİPEK), peritoneal karsinomatozisli seçilmiş hastalarda sağkalımı artıran etkili bir tedavi yaklaşımıdır. Bununla birlikte, özellikle gastrointestinal sistemle ilişkili komplikasyonlar morbiditeyi belirgin şekilde artırabilmektedir. Bu çalışmada, SRC ve oksaliplatin ile HİPEK uygulaması sonrası geç dönemde gelişen spontan jejunal perforasyon olgusunun sunulması ve olası etyopatogenetik mekanizmaların tartışılması amaçlanmıştır. Olgu Sunumu: Elli beş yaşında erkek hastada apendiks kökenli müsinöz adenokarsinom ve yaygın peritoneal karsinomatozis saptanması üzerine SRC ve 42,5 °C’de 30 dakika süreyle oksaliplatin bazlı HİPEK uygulanmıştır. Hasta postoperatif erken dönemi sorunsuz geçirerek taburcu edilmiştir. Ancak postoperatif 19. günde ateş ve karın ağrısı ile başvuran hastada jejunal anslarda perforasyon ve eşlik eden anastomoz kaçağı saptanmış, acil cerrahi müdahale ile jejunal rezeksiyon ve uç jejunostomi uygulanmıştır. Perfore segmentte tümör implantı veya cerrahi travmaya ait bulguya rastlanmamıştır. Tartışma: HİPEK sonrası gastrointestinal perforasyonlar genellikle erken dönemde bildirilmekte olup, geç dönemde ortaya çıkan spontan jejunal perforasyonlar nadirdir. Oksaliplatinin kısa yarı ömrüne rağmen, peritoneal dokularda sekestrasyon, hipertermiye bağlı subklinik doku hasarı, fibroblast fonksiyon bozukluğu ve yara iyileşmesindeki gecikmeler geç dönem perforasyonların olası nedenleri arasında yer almaktadır. Literatürde bu mekanizmaları doğrudan açıklayan yeterli veri bulunmamaktadır. Sonuç: SRC ve HİPEK sonrası gelişen geç dönem jejunal perforasyonlar nadir ancak ciddi komplikasyonlardır. Sunulan olgu, oksaliplatinin yüksek sıcaklıkta intraperitoneal kullanımının geç dönem gastrointestinal etkilerine dikkat çekmektedir. Bu bulgular, deneysel ve klinik çalışmalarla desteklenmesi gereken yeni araştırma alanlarına ışık tutmaktadır. Anahtar Kelimeler: Peritoneal karsinomatozis, sitoredüktif cerrahi, HİPEK, oksaliplatin, jejunal perforasyon

Anahtar Kelimeler

• peritonitis karsinomatozis
• hipek
• sitoredüktif cerrahi
• jejunal perforasyon
• oksaliplatin

Etik Beyan

This study is a single case report. According to the institutional ethics committee guidelines, ethics committee approval is not required for single case reports. Written informed consent for publication was obtained from the patient.

Late jejunal loop perforation following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritonitis carcinomatosis (PC).

Öz

Objective: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment strategy that improves survival in selected patients with peritoneal carcinomatosis. However, gastrointestinal complications remain a major source of morbidity. This report aims to present a case of late-onset spontaneous jejunal perforation following CRS and oxaliplatin-based HIPEC and to discuss possible underlying mechanisms. Case Presentation: A 55-year-old male patient diagnosed with appendiceal mucinous adenocarcinoma and extensive peritoneal carcinomatosis underwent CRS followed by oxaliplatin-based HIPEC at 42.5 °C for 30 minutes. The early postoperative course was uneventful, and the patient was discharged. On postoperative day 19, the patient was readmitted with fever and abdominal pain. Imaging revealed jejunal perforation accompanied by an anastomotic leak. Emergency laparotomy was performed, including resection of the perforated jejunal segment and creation of an end jejunostomy. No tumor implants or intraoperative injury were identified at the perforation site. Discussion: Gastrointestinal perforations after HIPEC are most commonly reported in the early postoperative period, whereas late spontaneous perforations are rare. Despite the short half-life of oxaliplatin, mechanisms such as peritoneal drug sequestration, hyperthermia-induced subclinical tissue injury, impaired fibroblast function, and delayed wound healing may contribute to late perforation. Current literature provides limited data addressing these mechanisms. Conclusion: Late-onset jejunal perforation following CRS and HIPEC is a rare but serious complication. This case highlights the potential long-term gastrointestinal effects of intraperitoneal oxaliplatin administered under hyperthermic conditions. Further experimental and clinical studies are warranted to better understand these mechanisms and to optimize patient safety.

Anahtar Kelimeler

• cytoreductive surgery
• hipec
• peritonitis carcinomatosis

Etik Beyan

Bu çalışma tek olguluk olgu sunumu niteliğinde olup, kurumumuz etik kurul yönergelerine göre etik kurul izni gerektirmemektedir. Olguda sunulan hastadan yayın için yazılı bilgilendirilmiş onam alınmıştır.

Kaynakça

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