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Surgical management of spontaneous bowel perforation and fascial dehiscence in a patient on bevacizumab and pembrolizumab in the setting of active Clostridium difficile infection
  1. Mujtaba Mubashir1,
  2. Brian Tang1,
  3. Robert L DeBernardo2 and
  4. Xiaoxi Feng1
  1. 1General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Mujtaba Mubashir; mujtabamubashir{at}


Immunotherapy such as bevacizumab and pembrolizumab is used to treat an increasing number of malignancies. These medications have been associated with poor wound healing and several gastrointestinal complications, including intestinal perforations in rare cases. We present a unique case of a patient with metastatic cervical cancer on pembrolizumab and recent bevacizumab therapy, presenting with a colonic perforation requiring urgent exploratory laparotomy, in the setting of active Clostridium difficile infection. She required a second laparotomy shortly after due to fascial dehiscence, where a synthetic absorbable mesh was used for fascial approximation. We review the factors that led to these events and describe the surgical technique used for safe abdominal closure.

  • Surgical oncology
  • Gastrointestinal surgery
  • Unwanted effects / adverse reactions
  • Gynecological cancer
  • Drug therapy related to surgery

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  • Contributors MM, BT, RLDB and XF developed the project outline MM and BT wrote the manuscript. RLDB and XF reviewed, revised and edited the 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.