Physician's Assistant

Email Thu 09 October 2025 17:51

Last Modified: 179 days ago

MRN:

Content:

Dear Doctor Neil,

Thanks for your advice regarding Mr BT (1441497). This is the 44-year-old gentleman currently being treated with pembrolizumab for metastatic melanoma who has developed immunotherapy-related colitis.

I can see in the notes and printouts from some emails between Dr Poles and the oncology team. Before coming into hospital he was opening his bowels 7 times per day with urgency and blood. He hasn't had any features of systemic illness.

I went to see him on the acute medical unit after our discussion about methylprednisolone and found that he actually hadn't opened his bowels for 3 days, passing nothing and no flatus.

His abdomen is generally tender and mildly distended although he does have bowel sounds.

At this moment it doesn't sound like he clearly has an exacerbation of his immunotherapy colitis however the possibility of an ileus, perforation or collection is a strong possibility in this immunocompromised man who has had long-standing colitis symptoms.

Therefore, I hope it's okay, that I have arranged a CT thorax abdomen and pelvis both for repeat staging as requested by the oncologist in their recent emails as well as to exclude ileus or complication. I've handed over to the AMU team to give him 1-2mg/kg of methylprednisolone in 2 divided doses if there are signs of ileus on the scan. If there's a complication like perforation or collection then I've suggested they speak to the surgical team in the first instance and stop his steroids.

I hope that you're happy with this plan. Please let me know if there's anything else you'd like me to do and I can make sure it's actioned.

I hope that your endoscopy goes well this evening.

Many thanks

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Email Thu 09 October 2025 17:51

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