Small-Bowel Pneumatosis Associated With FOLFOX Therapy in a Patient With Duodenal Adenocarcinoma: A Rare Case Report
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October 20, 2026
Objective:
To describe small-bowel pneumatosis arising during modified FOLFOX treatment for metastatic duodenal adenocarcinoma.
Approach:
- Case: A 61-year-old woman developed abdominal symptoms after nine cycles of dose-reduced FOLFOX.
- Evaluation: CT showed extensive small-bowel pneumatosis and mesenteric air, without portal venous gas, impaired bowel-wall enhancement, vascular thrombosis, obstruction, or free air.
- Management: FOLFOX was withheld. She received bowel rest, intravenous fluids, antibiotics, and correction of metabolic abnormalities, with surgical consultation.
Key Findings:
- The patient presented with abdominal pain, nausea, vomiting, weakness, and intermittent confusion; she remained hemodynamically stable and had no peritoneal signs, with leukocytosis and mildly elevated lactate.
- During a one-week hospitalization, abdominal pain resolved, leukocyte count normalized, and lactate returned to baseline without surgery.
- Blood cultures and stool testing identified no infectious source; the authors considered chemotherapy-associated pneumatosis the most likely diagnosis.
Interpretation:
The authors report that FOLFOX-associated small-bowel pneumatosis is uncommon and may resolve with conservative treatment when clinical and imaging findings do not indicate ischemia or perforation.
Limitations:
- This is a single case report and cannot establish causation.
- The proposed contributions of cumulative chemotherapy exposure, renal insufficiency, dehydration, and metabolic stress are hypotheses discussed by the authors.
Conclusion:
The patient improved with supportive management after FOLFOX was withheld, without surgical intervention.
Based on findings from:
FOLFOX-Induced Small-Bowel Pneumatosis in a Patient With Duodenal Adenocarcinoma: A Rare Case Report
Annals Of Internal Medicine: Clinical Cases, 2026.
https://www.acpjournals.org/doi/10.7326/aimcc.2026.0238
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