Possible Fruquintinib associated ischemic colitis in a patient with metastatic ampullary adenocarcinoma

Vascular endothelial growth factor receptor tyrosine kinase inhibitors, including fruquintinib, may predispose to ischemic colitis through microvascular dysfunction, even in the absence of large-vessel occlusion or traditional ischemic risk factors.Ischemic colitis should be considered in patients receiving or recently exposed to anti-angiogenic therapies who present with acute haematochezia and segmental colitis, despite delayed symptom onset after drug discontinuation.Early recognition, exclusion of alternative aetiologies, and prompt withdrawal of the suspected agent with supportive management can lead to favourable outcomes and may prevent progression to perforation or surgical intervention.