[Treatment of neutropenic enterocolitis].
BACKGROUND
Neutropenic enterocolitis is a life-threatening complication that usually occurs in connection with chemotherapy for acute leukemias. Our experience with diagnosis and treatment of these patients is presented.


METHODS
Medical records from patients treated for neutropenic enterocolitis at Ullevaal University Hospital in the period 2000-2008 were retrospectively reviewed.


RESULTS
16 patients with median age 33 years were treated for neutropenic enterocolitis. Induction chemotherapy was given for acute myelogenic (n = 9) or lymphatic (n = 4) leukemia, myelomatosis (n = 2) or lymphoma (n = 1). The patients developed aplasia five days (median) after start of chemotherapy. All patients were first treated conservatively with broad-spectrum antibiotics, fluids and electrolyte supplementation; nine of them recovered without complications. Four underwent surgery for perforation or ileus and these had the longest period with aplasia (median 31 days). Surgery for perforation is mainly limited resection and construction of ileostomy reservoirs (one or two). Three patients died. These were only treated conservatively; aplasia occurred quicker in these patients (after median two days) and they had the largest number of affected bowel segments (median nine).


CONCLUSIONS
Neutropenic enterocolitis is a heterogeneous condition and the treatment is mainly conservative. Surgical intervention is mandatory in patients with free intraabdominal air, ileus and intractable intestinal bleeding. The prognosis seems to worsen when aplasia develops after a short time and when there is a large number of affected bowel segments.
Gondal
Ghous
G
Gastrokirurgisk avdeling, Oslo universitetssykehus, Ullevål 0407, Oslo, Norway. ghousgondal@hotmail.com
Johnson
Egil
E
Paulsen
Vemund
V
Hasan
Banitalebi
B
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D044504:Enterocolitis, Neutropenic / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy; D008223:Lymphoma / Q000188:drug therapy; D008297:Male; D009101:Multiple Myeloma / Q000188:drug therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents