title: Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy.
abstract: Neutropenic enterocolitis (NEC) is a life-threatening disease with substantial morbidity and mortality, seen primarily in patients with hematologic malignancies. The frequency of NEC has increased with the widespread use of chemotherapeutic agents such as the taxanes, which cause severe gastrointestinal mucositis. Neutropenic patients with fever and abdominal symptoms (cramping, pain, distention, diarrhea, GI bleeding), should undergo evaluation of the abdomen for bowel wall thickening of >4 mm, the hallmark of NEC. Clostridium difficile infection should be ruled out, as well as other etiologies such as graft-versus-host disease. Complications include bacteremia, which is often polymicrobial, hemorrhage, and bowel wall perforation/abscess formation. Management includes bowel rest, correction of cytopathies and coagulopathies, and broad spectrum antibiotics and antifungal agents. Surgical intervention may be necessary to manage complications such as hemorrhage and perforation and should be delayed, if possible, until recovery from neutropenia.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. nesherl@yahoo.com
authors.forename: Lior
authors.initials: L
authors.lastname: Nesher
authors.forename: Kenneth V I
authors.initials: KV
authors.lastname: Rolston
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions; D044504:Enterocolitis, Neutropenic / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D016867:Immunocompromised Host; D009369:Neoplasms / Q000188:drug therapy*; D043823:Taxoids / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids