YO19 - Posterior Reversible Encephalopathy Syndrome associated with Pharmacological management of Bowel obstruction at the end of life – a review of two cases separated by 5 years

Case summary

Case details - A 31-year-old Female, a known case of Adenocarcinoma Colon, and a 72-yr-old female, a known case of metastatic Carcinoma Cervix with bladder and rectal involvement and hepatic metastasis post multiple lines of chemotherapy (most recently Carboplatin and Paclitaxel) who had been started on pharmacological management of Malignant Bowel obstruction with anti-secretory measures (including Octreotide) developed PRES during treatment. Both patients presented with Seizures and transient visual symptoms. While the first patient developed transient hypertension, which was managed with Labetalol, the second did not demonstrate any undue changes in vital signs during the course of the evaluation. Both these patients did not have any intracranial metastases on radiological evaluation. The clinical course in the second case was complicated by a prolonged (month-long) period of starvation before she became symptomatic. While Octreotide therapy had been ongoing in the first case, the second patient had just begun receiving it. Also, while the development of PRES proved to be a terminal event in the first case, the second case was discharged from the hospital against medical advice and subsequently lost to follow-up (during the Pandemic).

Discussion - Do metabolic abnormalities unique to the physiological milieu in advanced cancer (which may be exacerbated as a result of the co-occurrence of reduced oral intake, combined with the action of drugs used in the Management of inoperable Subacute Bowel Obstruction) predispose to the development of Seizures and Posterior Reversible Encephalopathy Syndrome? Does Octreotide have a definitive role in the etiopathogenesis of this complication? Does the combination of various classes of drugs used in the setting of MBO predispose to PRES? Does the type and duration of pre-existing chemotherapy also influence the likeliness of developing this complication?

Conclusion- Intensive Medical management of Syndromes at the end of life might lead to unique adverse events. Evaluating and studying these complications might provide unique insights into the understanding of their etiopathogenesis.

Clinical trial identification

Editorial acknowledgement