Spontaneous gastroduodenal perforation in patients with cancer receiving chemotherapy and steroids. Report of four cases combining 5-fluorouracil infusion and cisplatin with antiemetics dexamethasone

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Abstract
Background. Spontaneous gastroduodenal perforation is an uncommon but life‐threatening complication of systemic chemotherapy and/or steroids. Here, the authors reported four cases of gastroduodenal perforation following combined chemotherapy with steroids. Methods. The chemotherapeutic regimens all included 5‐fluorouracil (5‐FU) by continuous infusion and cisplatin. The authors used dexamethasone as an antiemetic. All patients took analgesics for pain relief. No patient had a history of peptic ulcer disease. Results. Severe epigastralgia occurred 3–5 days after the start of chemotherapy. The peptic ulcer perforations were diagnosed within 3 days of onset of symptoms. All patients had an emergency laparotomy. Three of the perforations were located in the duodenum and one was located in the stomach. Pathologic examination of one patient revealed a chronic peptic ulcer. Two patients with preoperative shock died in the postoperative period. Conclusions. The cause of spontaneous gastroduodenal perforation is not known, but the etiology can be complex. Either 5‐FU or steroids can induce the perforation. An asymptomatic peptic ulcer may be aggravated by 5‐FU, cisplatin, or dexamethasone. The authors suggest that patients receiving 5‐FU infusion and cisplatin with dexamethasone for antiemesis who complain of epigastric pain should be mentioned for a gastroduodenal ulcer or even a perforation.