Small bowel obstruction in patients associated with immune checkpoint inhibitors combined with chemotherapy: Two case reports and a review

Rationale: The broader application of immune checkpoint inhibitors (ICIs) has led to increased recognition of rare but clinically significant adverse effects (AEs), including small bowel obstruction (SBO). This case aims to elucidate the clinical features and management challenges of ICI-associated SBO. Patient concerns: The first case involves a 67-year-old male patient with esophageal malignancy who was hospitalized due to painful abdominal distension following the 2 cycles administration of tislelizumab in conjunction with nab-paclitaxel. The second case concerns a 59-year-old male patient with pancreatic malignancy who developed abdominal pain and distension after undergoing combination capecitabine with sintilimab. Diagnoses: Imaging confirmed incomplete SBO in the first patient, while the second showed SBO with abdominal effusion. Interventions: In consideration of the AEs associated with ICI therapy, the patient was treated with glucocorticoids. Initial management included fasting, and administration of cefoperazone–sulbactam for anti-infection therapy along with methylprednisolone. Another patient underwent catheter placement and received octreotide treatment, but the therapeutic response was unsatisfactory. Outcomes: The patient 1 symptoms gradually improved. However, despite therapy, the patient 2’s SBO did not improve, and he was subsequently transferred to the hospital for further management. Lessons: With expanding use of ICIs, immune-related AEs have emerged. Clinicians should remain highly vigilant for gastrointestinal symptoms in patients receiving ICIs, as early recognition of SBO is crucial for timely diagnosis and treatment.