Recovery from severe bowel and oesophageal complications after breast cancer chemotherapy

What happened, in summary

A 48-year-old woman received her first neoadjuvant cycle of docetaxel, carboplatin, trastuzumab, and pertuzumab for HER2-positive cancer of the left breast. Eleven days later, she arrived at the emergency department with abdominal and back pain and was found to be profoundly neutropenic. CT findings were consistent with neutropenic enterocolitis, and she required admission to intensive care for fluids, vasopressors, and escalating respiratory support.

Her condition became life-threatening. She experienced cardiac arrest during intubation but recovered circulation quickly. Pleural cultures and contrast imaging then revealed an oesophageal perforation. She was transferred for oesophageal stenting and later developed pulmonary embolism, deep-vein thrombosis, caecal perforation, and severe sepsis. Treatment included antimicrobials, pleural drainage, bilateral thoracotomies and decortication, right hemicolectomy, nutritional support, physiotherapy, and psychiatric care. She spent 71 days in intensive care and 89 days in hospital overall.

After tracheostomy weaning and rehabilitation, she returned home independently with a good quality of life. Curative left mastectomy with axillary clearance and delayed reconstruction was initially planned, but surgery was deferred while she recovered and because of the COVID-19 outbreak. Tamoxifen was started in the interim. Three months after intensive-care discharge, no operation was yet scheduled. Her case reflects both a major treatment complication and substantial physical and psychological recovery, while definitive breast cancer care remained ongoing.