[Neutropenic enterocolitis in adult patients with acute leukemia or stem cell transplant recipients: study of 7 cases].
OBJECTIVE
Neutropenic enterocolitis (NE) is a complication arising in neutropenic patients with acute leukemia or solid tumours while treated with intensive chemotherapy. The optimal therapeutic procedures have not been well established.


METHODS
Seven cases of NE diagnosed and treated in a tertiary hospital between 2000 and 2007 are described. Their clinico-biological characteristics, therapeutic procedures and evolution were analysed retrospectively.


RESULTS
Five of the patients were males, their median age was 39 years. Acute myeloblastic leukemia was the most frequent diagnosis (5 cases). Two other patients had received an stem cell transplantation. Abdominal pain was present in all patients, diarrhoea in 6, and fever in 5. Microorganisms were isolated from blood cultures in 4 cases (Clostridium septicum, Escherichia coli, Pseudomonas aeruginosa and Aeromonas hydrophila). Abnormal mural thickening of the caecum was observed in the 6 cases in which a computed tomography scan could be performed. The median mural thickness at its maximum section was 11 mm (range: 8-16). All patients first received medical treatment with wide spectrum antibiotics and intestinal rest, and abdominal surgery was indicated in 6 cases after a median time from first symptom of 4 days (range: 0-12). NE was confirmed histologically in all 6 patients. Five patients required admission in Intensive Care Unit and 2 (29%) died as a result of NE.


CONCLUSIONS
NE is a severe complication of patients with hematologic malignancies submitted to intensive chemotherapy or receiving stem cell transplantation. Abdominal computed tomography scan is the most valuable diagnostic tool. Prompt surgical intervention may improve the prognosis in patients with NE.
Batlle
Montserrat
M
Servicio de Hematología Clínica. Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona. España. mbatlle@iconcologia.net
Vall-Llovera
Ferran
F
Bechini
Jordi
J
Camps
Ignasi
I
Marcos
Pilar
P
Vives
Susana
S
Oriol
Albert
A
Ribera
Josep-Maria
JM
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D044504:Enterocolitis, Neutropenic / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents