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We present a unique case of a patient with metastatic cervical cancer on pembrolizumab and recent bevacizumab therapy, presenting with a colonic perforation requiring urgent exploratory laparotomy, in the setting of active <jats:italic>Clostridium difficile<\/jats:italic> infection. She required a second laparotomy shortly after due to fascial dehiscence, where a synthetic absorbable mesh was used for fascial approximation. We review the factors that led to these events and describe the surgical technique used for safe abdominal closure.<\/jats:p>","DOI":"10.1136\/bcr-2022-253815","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T11:01:45Z","timestamp":1683111705000},"page":"e253815","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical management of spontaneous bowel perforation and fascial dehiscence in a patient on bevacizumab and pembrolizumab in the setting of active <i>Clostridium difficile<\/i> infection"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1387-0684","authenticated-orcid":false,"given":"Mujtaba","family":"Mubashir","sequence":"first","affiliation":[{"name":"General Surgery, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Tang","sequence":"additional","affiliation":[{"name":"General Surgery, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L","family":"DeBernardo","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxi","family":"Feng","sequence":"additional","affiliation":[{"name":"General Surgery, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,3]]},"reference":[{"key":"2025082708225221000_16.5.e253815.1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2014-0330"},{"key":"2025082708225221000_16.5.e253815.2","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/SAP.0b013e31824e5e57","article-title":"Bevacizumab and wound-healing complications: mechanisms of action, clinical evidence, and management recommendations for the plastic surgeon","volume":"71","author":"Sharma","year":"2013","journal-title":"Ann Plast Surg"},{"key":"2025082708225221000_16.5.e253815.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31999-8"},{"key":"2025082708225221000_16.5.e253815.4","unstructured":"Flynn JP , Gerriets V . 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