PT  - JOURNAL ARTICLE
AU  - Carolina Palmela
AU  - Catarina Gouveia
AU  - Catarina Fidalgo
AU  - Alexandre Oliveira Ferreira
TI  - Rare case of a giant duodenal ulcer penetrating the pancreas during antiangiogenic treatment
AID  - 10.1136/bcr-2018-228612
DP  - 2019 May 01
TA  - BMJ Case Reports
PG  - e228612
VI  - 12
IP  - 5
4099  - http://casereports.bmj.com/content/12/5/e228612.short
4100  - http://casereports.bmj.com/content/12/5/e228612.full
SO  - BMJ Case Reports2019 May 01; 12
AB  - We report a case of a patient with renal cell carcinoma on pazopanib, who presented with severe upper gastrointestinal bleeding. Endoscopy showed a giant bulbar ulcer with a visible vessel of 4 mm. Due to unavailability of surgical rescue backup, large calibre vessel treatment was delayed. Endoscopy was repeated after 48 hours and showed a reduction in the vessel diameter. Endoscopic adrenalin injection and electrocoagulation were performed. However, the vessel increased in size and became pulsatile. The patient was operated, confirming a giant bulbar ulcer penetrating the pancreas with active bleeding from the gastroduodenal artery. Pazopanib therapy was suspended, and the patient is asymptomatic. Antiangiogenic treatment has been associated with gastrointestinal bleeding, perforation and fistulisation. Although we cannot confirm the causal association between the penetrating ulcer and pazopanib, the absence of Helicobacter pylori infection or non-steroidal anti-inflammatory drugs, and the reported cases of gastrointestinal bleeding during these therapies favour a possible association.