Supplementary Material for: The Role of Abdominal Surgery in Refractory Immune Checkpoint Inhibitor Enterocolitis: A Case Report

This article describes the case of a 73-year-old patient with grade 3 immune checkpoint inhibitor (ICI)-induced enteritis. Five different immunosuppressive agents (glucocorticoids, high-dose infliximab, methotrexate, mycophenolate mofetil, and vedolizumab) were administered, however, with no clinical or radiographical benefit. A laparotomy was performed, as the patient showed signs of intestinal obstruction, with a segmental resection of the ileal loop. Biopsy results showed multiple fibrotic strictures. The current treatment guidelines for ICI enterocolitis only include drugs as a treatment option. Nevertheless, it remains important to consider early surgical intervention in order to avoid serious complications due to persistent and pronounced inflammation. The current case highlights the importance of surgery as a treatment modality in the multidisciplinary approach for ICI-induced enteritis, which should be taken into consideration after second- or third-line treatment.

本文报告了1例73岁患者罹患3级免疫检查点抑制剂（immune checkpoint inhibitor, ICI）相关性肠炎的病例。临床先后予5种不同免疫抑制剂治疗，包括糖皮质激素、大剂量英夫利昔单抗、甲氨蝶呤、吗替麦考酚酯及维多珠单抗，但未获得临床及影像学获益。因患者出现肠梗阻征象，遂行剖腹探查术并行回肠袢节段切除术。术后病理活检提示存在多发纤维化狭窄。当前针对免疫检查点抑制剂相关性结肠炎的临床治疗指南仅将药物疗法列为可选治疗手段。尽管如此，仍需重视早期外科干预的价值，以规避因持续且显著的炎症反应导致的严重并发症。本病例凸显了外科手术在免疫检查点抑制剂相关性肠炎多学科诊疗模式中的重要地位，建议在二线或三线药物治疗后予以考虑。