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The surgical management of abdominal pain in the multiple myeloma patient
Jared Garrett1, V Suzanne Klimberg, Elias Anaissie
1Department of Surgery, The University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, USA.
Background:
The purpose of this retrospective study was to characterize the presentation, treatment, and outcomes of patients with multiple myeloma requiring surgical evaluation for abdominal pain.
Methods:
Medical records of patients with myeloma and abdominal pain evaluated by surgery over a period of 18 months were examined.
Results:
Twenty-one patients underwent surgical evaluation, with 23 diagnoses. Neutropenic enterocolitis (n = 5 [22%]) and ileus (n = 4 [17%]) were common diagnoses. Eleven patients (52%) were neutropenic. Peritonitis was noted in only 1 patient. Eastern Cooperative Oncology Group performance status was either 3 or 4 in most patients (67%). Surgery was performed in 5 patients. The 90-day mortality rate for all patients was 43%, with all deaths secondary to sepsis in patients managed without surgery.
Conclusions:
Patients with myeloma requiring surgical evaluation for abdominal pain have a unique differential diagnosis, with notable findings at presentation including the presence of cytopenia, lack of peritoneal signs, and low performance status.
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