Neutropenic enterocolitis: is there a right timing for surgery? Assessment of a clinical case.
Neutropenic enterocolitis is a severe and potentially life-threatening complication that may affect patients undergoing chemotherapy for acute leukemia or lymphoma. These patients may develop systemic sepsis through bacterial or fungal translocation across the intestinal wall. In many cases neutropenic enterocolitis is confined to the cecum, but the entire colon is sometimes involved. Most patients are treated conservatively because an improvement occurs when the absolute neutrophil count rises. However, a surgical approach consisting of resection of the colon may sometimes be necessary, even in patients with complete aplasia and a high risk of complications. The right time to perform surgery is hard to define. Intestinal wall thickness, evaluated by ultrasound, is an important prognostic factor which could act as a guide to surgical indication. We analyze a case of neutropenic enterocolitis which occurred in a patient with acute myeloid leukemia during chemotherapy and we suggest that, as well as intestinal wall thickness, hemodynamic worsening should be considered an indication for surgery.
Bagnoli
Pietro
P
Department of Surgical Oncology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. pietro.bagnoli@humanitas.it
Castagna
Luca
L
Cozzaglio
Luca
L
Rossetti
Carlo
C
Quagliuolo
Vittorio
V
Zago
Mauro
M
Santoro
Armando
A
Doci
Roberto
R
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003082:Colectomy / Q000379:methods / Q000592:standards*; D003561:Cytarabine / Q000009:adverse effects; D003630:Daunorubicin / Q000009:adverse effects; D044504:Enterocolitis, Neutropenic / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D003561:Cytarabine; D003630:Daunorubicin