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Case report
Case of small bowel perforation secondary to nivolumab and ipilimumab related tumour regression
  1. Kishen Rajan Patel1,
  2. Lennard YW Lee1,
  3. Arvind Tripathy1 and
  4. David McKean2
  1. 1Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2Radiology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
  1. Correspondence to Dr Kishen Rajan Patel; kishen.patel1{at}


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.

  • oncology
  • skin cancer

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  • Contributors KRP was the primary author who wrote and edited the manuscript. LYWL primarily supervised KRP and provided advice and expertise on the subject of melanomas and immunotherapy. AT provided imaging, edited and provided a clinical oncology opinion the case study. DMK provided an expert radiology opinion on the imaging used in the case study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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