Passage of intestinal (small bowel) cast--an unusual complication of neutropenic sepsis.

Summary A 52-year-old woman was admitted with neutropenic sepsis, 3 days following the final cycle of adjuvant chemotherapy for breast cancer. Her condition deteriorated with progressive abdominal distension, bilious vomiting and diarrhoea. Abdominal examination revealed a mild degree of peritonism. Five days later she passed a small bowel cast per rectum, showing gross fungal contamination on histology. She was managed conservatively with antibiotics and antifungal medications and nutritional support. BACKGROUND The spontaneous passage per rectum of a partial thickness ‘small bowel cast’ is an extremely rare occurrence. Cases of passage of colonic cast following chemotherapy or major abdominal surgery have been reported. We report a patient who spontaneously passed a long, partially thick, small bowel cast and use it to illustrate this rare side-effect. Also, we are reporting the case to advocate the consideration of conservative management.