Acute abdomen in patients receiving chemotherapy.
OBJECTIVE
To assess the incidence of acute abdomen in patients receiving chemotherapy and to evaluate the factors affecting the clinical decision-making.


METHODS
Retrospective analysis of surgical oncology references for the patients developing acute abdomen while receiving chemotherapy was carried out. A surgical oncologist reviewed each referral and a full work-up was carried out. Surgical interventions were carried out as and when deemed necessary. Response to treatment, whether surgical or conservative, was used as main outcome variable.


RESULTS
Mean age of the patients was 37 years (7-58 years). Half of the patients were receiving chemotherapy for lymphoproliferative disorders, 13 for haematological malignancies and 3 for ovarian cancer. Clinical diagnosis was of acute appendicitis in 13, paralytic ileus in 9, typhilitis in 3 and intestinal perforation in 2, acute intestinal obstruction in 3, and obstructed hernia and intussception in one each. Six patients underwent surgery. Two patients expired postoperatively of progressive septicaemia and multi-system organ failure.


CONCLUSIONS
Evaluation of cancer patients on chemotherapy is difficult. Tenderness, presence of peritoneal signs and absence of exaggerated bowel sounds are most important clinical signs, however they may be blunted by progressive neutropenia or corticosteroid administration. Decision to operate, should be made with extreme caution as mortality and morbidity after surgery is high.
Pandey
M
M
Department of Surgical Oncology, Regional Cancer Centre, Medical College P.O., Trivandrum-695011, Kerala, India.
Mathew
A
A
Geetha
N
N
Sebastian
P
P
Ahamed
I M
IM
Nair
M K
MK
D000006:Abdomen, Acute / Q000139:chemically induced / Q000175:diagnosis* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008232:Lymphoproliferative Disorders / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000970:Antineoplastic Agents