FOLFOX-Induced Small-Bowel Pneumatosis in a Patient With Duodenal Adenocarcinoma: A Rare Case Report

FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) is widely used in gastrointestinal malignancies. Gastrointestinal toxicity is common, whereas pneumatosis intestinalis is rare. We aim to describe chemotherapy-associated small-bowel pneumatosis during modified FOLFOX therapy. We present a 61-year-old woman with metastatic duodenal adenocarcinoma receiving dose-reduced FOLFOX presenting with abdominal pain, nausea, vomiting, and confusion. Laboratory studies showed leukocytosis and an elevated lactate level. Computed tomography revealed small-bowel pneumatosis with mesenteric air tracking without perforation. She remained hemodynamically stable. Conservative management resulted in improvement. FOLFOX-associated pneumatosis intestinalis is potentially reversible. Recognition of clinical stability and supportive management may prevent unnecessary surgery and allow continuation of oncologic therapy.