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Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis
  1. Megha Bhadbhade1,2,
  2. Elizabeth Connolly3,4,
  3. Sarit Badiani1,2,
  4. David Yeo4,5 and
  5. Vivek Bhadri3,4
  1. 1Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
  2. 2Department of Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia
  3. 3Sarcoma Unit, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
  4. 4Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Megha Bhadbhade; megha.bhadbhade{at}


Osteosarcoma is the most common paediatric and adolescent primary bone malignancy and is highly chemosensitive. Gastrointestinal metastases from osteosarcomas are rare. Bowel perforation secondary to chemotherapy is a potential serious complication reported in ovarian, colorectal and haematological malignancies. We report the first documented case of chemotherapy-mediated bowel perforation in an osteosarcoma patient with gastrointestinal metastases. A man in his 20s, with a history of resected osteosarcoma in remission, presented with abdominal pain. A computed tomography (CT) scan demonstrated a large calcified intrabdominal mass (15×13×9 cm) consistent with new peritoneal disease. After one cycle of palliative ifosfamide and etoposide chemotherapy, he developed a large bowel perforation and neutropenic sepsis consequently requiring resection of the perforated mass. Chemotherapy-induced bowel perforation is a rare but serious complication that should be considered in patients with osteosarcoma, and other chemosensitive malignancies, with intra-abdominal metastases. Recommencement of systemic therapies after bowel complications must be assessed cautiously on a case-by-case basis.

  • Chemotherapy
  • Malignant disease and immunosuppression
  • Surgical oncology

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  • Contributors All authors helped in the management of the patient. EC collected the patient’s clinical data. MB and EC drafted the manuscript. All authors revised the manuscript. EC and VB provided supervision. All authors read and approved the final manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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