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Neutropenic enterocolitis. Clinical diagnosis and treatment
D S Wade1, H R Nava, H O Douglass
1Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Cancer
|January 11, 1992
Summary
Neutropenic enterocolitis is difficult to diagnose, with many cases misdiagnosed at autopsy. Early nonoperative management is recommended, with surgery reserved for complications like perforation.
Area of Science:
- Gastrointestinal Surgery
- Surgical Oncology
- Hematology
Background:
- Neutropenic enterocolitis (NE) is a severe complication in patients with hematologic malignancies undergoing chemotherapy.
- Accurate diagnosis of NE is challenging, impacting treatment decisions and patient outcomes.
Purpose of the Study:
- To review the accuracy of the clinical diagnosis of neutropenic enterocolitis.
- To evaluate treatment outcomes for patients with suspected NE.
Main Methods:
- Retrospective review of 22 patients with a clinical diagnosis of NE at Roswell Park Memorial Institute (1982-1987).
- Analysis of autopsy findings to confirm clinical diagnoses.
- Comparison of outcomes between nonoperative and operative management.
Main Results:
- Ninety-one percent of patients had hematologic malignancies and 95% received cytotoxic chemotherapy.
- Autopsy confirmed NE in only 4 of 9 cases; 4 had normal intestines, and 1 had volvulus.
- Nonoperative management (16 patients) resulted in 11 deaths, while surgery (6 patients) had 3 survivors.
Conclusions:
- Neutropenic enterocolitis should be considered a diagnosis of exclusion due to diagnostic challenges.
- Individualized care is crucial; initial nonoperative management (bowel rest, antibiotics) is recommended.
- Surgical intervention is indicated for suspected perforation or clinical deterioration despite conservative treatment.