Abstract
Background: Cisplatin is a platinum-based chemotherapeutic agent with wide complications including life-threatening acceleration of venous and arterial thrombosis. Cisplatin associated thrombosis occurs through triggering platelet activation.
Objectives: The aim of this study is to present a case of non-keratinizing undifferentiated nasopharyngeal cancer who had cisplatin chemotherapy.
Methods: We present a 56 year old male admitted to Al-Hada emergency department complaining of diffuse severe abdominal pain associated with nausea at the onset of the pain and constipation one day ago. He was diagnosed with non-keratinizing undifferentiated nasopharyngeal cancer and started chemotherapy of 2 doses of Cisplatin and 12 doses radiotherapy.
Results: On abdominal examination there was generalized guarding and tenderness and the abdomen was distended. There was no organomegaly, bowel sound was scanty, and empty rectum in digital examination. Abdominal X-ray revealed distended small bowel and no air fluid level. There was sinus rhythm on ECG. His WBC count was 19 x 10 3/mu L, and lactic acid level was 9.6 mmol/L. Abdominal contrast enhancement computed tomography showed a large filling defect at the proximal part of the superior mesenteric artery with dilated bowel and porto-mesenteric gas pneumatosis intestinalis. The filling defect seen was obliterating the superior mesenteric artery's lumen denoting acute arterial obstruction distally to its terminal branches. Exploration laparotomy showed heavily necrotic bowel from 30 cm distal to duodenojejunal junction down to 50cm proximal to ileocecal valve, with an area of engorged bowel proximal to that (similar to 50 cm, more toward ischemic). After immediate resuscitation with D5 normal saline and intravenous ceftriaxone the patient became oliguric and tachycardic. The patient was admitted to the ICU and labelled as Do-Not-Resuscitate (DNR) and arrested after 6 hours.
Conclusion: In this study, thromboembolic events (TEEs) occurred within the first 100 days of starting cisplatin. TEE prophylaxis is advisable for patients receiving cisplatin-based chemotherapy.