Gastrointestinal surgical emergencies in patients treated for hemathological malignancies.
BACKGROUND
Upper and lower gastrointestinal symptoms are major and serious complications in patients who undergo chemotherapy for hematological malignancies. Their most frequent causes are acute intestinal graft-versus-host disease (GVHD) after bone marrow transplant, infections, toxicity or preexisting gastrointestinal diseases. Mortality can reach 30-60% of cases.


METHODS
We report 15 cases operated on for abdominal emergencies: 3 severe gastrointestinal bleeding and 12 acute abdomen.


RESULTS
We performed 10 bowel resections, one cholecystectomy, one splenectomy, two laparotomy with pancreatic debridement and peritoneal lavage, and one suture of perforated peptic ulcer. Operative mortality was 33.3% (5/15). Deaths have been reported only in the group of patients with acute abdomen. In all cases death was correlated to generalized sepsis related to immunosuppression.


CONCLUSIONS
We believe that an aggressive approach, consisting of close monitoring and early laparotomy combined with vigorous supportive therapy, should be used when dealing with suspected gastrointestinal complications in patients with hematological malignancies.
Caronna
R
R
Cattedra di Chirurgia d'Urgenza II, Istituto Dipartimentalizzato di Chirurgia d'Urgenza e di Pronto Soccorso.
Cardi
M
M
Arcese
W
W
Iori
A P
AP
Martelli
M
M
Catinelli
S
S
Mangioni
S
S
Corelli
S
S
Priore
F
F
Tarantino
E
E
Frantellizzi
V
V
Spera
G
G
Borrini
F
F
Chirletti
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged