title: Neutropenic enterocolitis: is there a right timing for surgery? Assessment of a clinical case.
abstract: 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.
authors.affiliation: Department of Surgical Oncology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. pietro.bagnoli@humanitas.it
authors.forename: Pietro
authors.initials: P
authors.lastname: Bagnoli
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzaglio
authors.forename: Carlo
authors.initials: C
authors.lastname: Rossetti
authors.forename: Vittorio
authors.initials: V
authors.lastname: Quagliuolo
authors.forename: Mauro
authors.initials: M
authors.lastname: Zago
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.forename: Roberto
authors.initials: R
authors.lastname: Doci
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D003561:Cytarabine; D003630:Daunorubicin