title: Indications for surgical intervention for gastrointestinal emergencies in children receiving chemotherapy.
abstract: BACKGROUND
  Abdominal pain in children receiving chemotherapy for cancer presents the clinician with unique problems due to the altered immunity of these patients or to the oncologic setting. The major clinical decisions regarding these patients are to determine if and when operative intervention is indicated.
  
  
  METHODS
  A retrospective study was done to examine the clinical, radiographic, and laboratory findings that indicate the need for surgical intervention. Sixty-eight of 1090 children who underwent treatment for cancer from October 1982 to December 1990 developed abdominal complaints requiring them to be hospitalized. Nineteen of these patients underwent exploratory laparotomy (operative), and the other 49 were observed (nonoperative).
  
  
  RESULTS
  No significant differences were observed in the phase of chemotherapy, treatment with vincristine or corticosteroids, or the hematologic indices between the operative and nonoperative groups. Eighteen of nineteen patients survived their surgeries. Seventeen (89%) of these laparotomies were positive based on the surgical pathology and the operative report. Peritoneal signs on physical examination (P < 0.001) or pneumatosis intestinalis on abdominal radiographs correlated with positive laparotomies (P = 0.001).
  
  
  CONCLUSIONS
  Peritoneal signs on physical examination or pneumatosis intestinalis on abdominal X-rays were associated with and specific for the presence of acute surgical disease of the abdomen in immunocompromised pediatric oncology patients.
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital, Denver.
authors.forename: C C
authors.initials: CC
authors.lastname: Silliman
authors.forename: G M
authors.initials: GM
authors.lastname: Haase
authors.forename: J D
authors.initials: JD
authors.lastname: Strain
authors.forename: D W
authors.initials: DW
authors.lastname: Luckey
authors.forename: M A
authors.initials: MA
authors.lastname: Blake
authors.forename: S A
authors.initials: SA
authors.lastname: Caldwell
authors.forename: H L
authors.initials: HL
authors.lastname: Wilson
authors.forename: L F
authors.initials: LF
authors.lastname: Odom
authors.forename: J L
authors.initials: JL
authors.lastname: Ater
authors.forename: B S
authors.initials: BS
authors.lastname: Greffe
mesh_terms: D000006:Abdomen, Acute / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000150:complications / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007813:Laparotomy; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D010808:Physical Examination; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents