本案例為28歲男性大腸癌病患，診斷為Duke’s D期合併腹膜播種性轉移。評估病情後隨即在93年5月26日施行消化道繞道手術。然而病人並未在本院繼續接受治療，轉而尋求氣功等另類療法。
六個月後病人因腹脹再次回診，醫師評估後給予緩解性化學治療，每兩週靜脈注射bevacizumab（5mg/kg）合併24小時持續輸注HDFL（high dose 5-fluorouracil and leucovorin）。然而病人接受三次治療後23天即因感染入院，經抗生素治療後病情緩解。出院後9天，又因為發燒、呼吸急促、腹脹、黃疸等症狀就醫，其生化檢驗值呈現白血球增加（WBC 25,000/L）、肝腎功能異常（Total bilirubin 14.0 mg/dL, BUN 141 mg/dL, Cr 4.2 mg/dL, ALP 253 U/L）、血小板減少（PLT 4000 /L）等情形。因病人雖給予嗎啡仍持續腹痛，經腹部電腦斷層掃描後診斷為腸穿孔與腹腔內膿瘍。雖然腫瘤本身也可能有腸穿孔的併發症，但仍無法排除是bevacizumab引起的不良反應。因病人不適合進行手術治療，而採取抗生素、週邊靜脈營養等保守性治療，但最後仍宣告不治死亡。
文獻資料顯示bevacizumab引起胃腸穿孔的發生率約在0.6~2.3%左右。但此副作用在臨床試驗之外發生率卻不得而知，且病理機轉目前並不清楚。因此臨床上使用bevacizumab時，醫療人員需特別注意此藥品致死之藥品不良反應。

A 28-year-old man presented with advanced colon cancer and carcinomatosis. He had undergone ileotransversostomy and gastrojejunostomy on May 26, 2004. The patient did not come back for follow-up after surgery.
After 6 months, he developed relapse with severe abdominal fullness. The complete blood count and biochemistry data were within the normal ranges. He was treated with bevacizumab 5mg/kg every other week plus high dose 5-fluorouracil and leucovorin. Twenty-three days after the third cycle of chemotherapy, he was admitted because of infection. Chemotherapy was held due to poor performance status. And the patient was discharged after antibiotic therapy. He was readmitted because of high fever, shortness of breath, abdominal fullness, and jaundice. His laboratory data revealed leucocytosis, abnormal hepatic/renal functions. He developed severe abdominal pain although opioids were prescribed. CT scan showed abnormal air in right lower quadrant area. Bevacizumab-associated bowel perforation was suspected. Nevertheless, the association with tumor itself can’t be ruled out. Operation was not performed due to risk of high mortality. Supportive care with antibiotics and nutrition supplement were started. He died of a consequence of his septic condition.
Gastrointestinal perforation have been observed in 0.6~2.3% of patients treated with bevacizumab. However, the rate of this side effect outside of clinical trials is unknown and the pathophysiology is not yet understood. Clinicians should carefully look for this side effect in patients undergoing therapy with bevacizumab.