title: [Neutropenic enterocolitis in children with cancer].
abstract: OBJECTIVE
  Neuropenic enterocolitis (NEC) is a destructive lesion of the ileocecal region occurring in cancer patients treated with chemotherapy. Its clinical picture is one of febrile acute abdominal extension with bloody diarrhea and low neutrophil counts. Our aim was to determine the incidence of NEC in children with cancer and to review the indications of surgery in these cases.
  
  
  METHODS
  The records of children with cancer treated with chemotherapy in the last 6 years at Hospital Infantile La Paz were reviewed. We selected those patients who had abdominal pain and neutropenia and whose physical examination and radiological findings were consistent with NEC.
  
  
  RESULTS
  Twelve cases of NEC were diagnosed during this period among 432 malignancies. The symptoms most frequently seen were abdominal pain and distension, nausea and vomiting. The neutrophil count was consistently below 500/ml. All patients were receiving chemotherapy before the onset of the clinical picture. Five children were operated upon. In three of these we found various ileocecal perforations, in one a gastric perforation and in the remaining one a diffuse inflammation of the ileocecal area. Two non-operated patients died from NEC. The remaining children recovered without problems with medical therapy.
  
  
  CONCLUSIONS
  Pediatric surgeons treating neutropenic cancer patients should be familiar with this condition, that must be suspected early in granulocytopenic patients with acute abdominal extension. Aggressive surgical management is indicated in cases with severe peritonitis, bowel perforation or massive lower gastrointestinal bleeding, irrespective of the degree of neutropenia. Medical support should aim at reestablishing normal neutrophil counts.
authors.affiliation: Departamento de Cirugía Pediátrica, Hospital Infantil La Paz, Madrid.
authors.forename: L
authors.initials: L
authors.lastname: Martínez Martínez
authors.forename: A
authors.initials: A
authors.lastname: Sastre Urgellés
authors.forename: L
authors.initials: L
authors.lastname: Ortega Martínez de Victoria
authors.forename: A
authors.initials: A
authors.lastname: Fernández Sánchez
authors.forename: J C
authors.initials: JC
authors.lastname: López Gutierrez
authors.forename: D
authors.initials: D
authors.lastname: Vallejo Díaz
authors.forename: M
authors.initials: M
authors.lastname: Perdiguero Martínez
authors.forename: B
authors.initials: B
authors.lastname: Velasco Sánchez
authors.forename: R
authors.initials: R
authors.lastname: Díez Pascual
authors.forename: R
authors.initials: R
authors.lastname: Lobato Romera
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar Larrucea
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004358:Drug Therapy; D004760:Enterocolitis / Q000150:complications* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D009503:Neutropenia / Q000150:complications*; D012189:Retrospective Studies; D015996:Survival Rate