title: Ultrasound findings guided a successful hemicolectomy in a leukemic patient with neutropenic enterocolitis.
abstract: BACKGROUND
  Neutropenic enterocolitis (NEC) can be a life-threatening complication of chemotherapy in leukemic patients. Early diagnosis and treatment is therefore crucial.
  
  
  METHODS
  A 38-year-old woman with acute lymphoblastic leukemia and chemotherapy-induced neutropenia suddenly developed symptoms suspicious of NEC. Transabdominal ultrasound showed features consistent with NEC, later confirmed by computed tomography (CT) scan.
  
  
  RESULTS
  The patient was scanned using portable ultrasound (US) equipment (Esaote My Lab 25). US findings showed involvement of the cecum, appendix, ascending colon and proximal middle transverse colon, with features resembling gas containing fissures within the colon wall itself. The risk of colon rupture was confirmed by CT scan. The patient underwent successful hemicolectomy after intravenous treatment with broad spectrum antibiotics, granulocyte-colony stimulating factor (G-CSF), platelets and fresh frozen plasma transfusion.
  
  
  CONCLUSIONS
  A prompt bedside US examination upon development of symptoms allowed an early diagnosis of NEC and identified features consistent with imminent colon wall rupture, shifting the management of this life-threatening complication from medical to surgical. Multidisciplinary intervention was crucial for a successful hemicolectomy in a severely affected neutropenic patient.
authors: Department of Oncology, Transplant and New Advances in Medicine, Division of Hematology, University of Pisa, Italy ; SIUMB Basic Course & Emergency School of Echography (SIUMB - Italian Society of Ultrasound in Medicine and Biology), Italy.
authors: E
authors: E
authors: Benedetti
authors: P V
authors: PV
authors: Lippolis
authors: F
authors: F
authors: Caracciolo
authors: S
authors: S
authors: Galimberti
authors: F
authors: F
authors: Papineschi
authors: M
authors: M
authors: Pelosini
authors: D
authors: D
authors: Focosi
authors: S M
authors: SM
authors: Stella
authors: E
authors: E
authors: Neri
authors: M
authors: M
authors: Seccia
authors: M
authors: M
authors: Petrini
keywords: Enterocolitis; Hemicolectomy; Leukemia; Neutropenic; Ultrasound sonography
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