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Surgical management of neutropenic enterocolitis
Insights
Neutropenic enterocolitis, a serious complication of chemotherapy in leukemia patients, often presents as acute abdomen. Surgical intervention is recommended to remove localized septic foci until marrow regeneration occurs.
Area of Science:
- Gastroenterology
- Oncology
- Surgical Oncology
Background:
- Neutropenic enterocolitis (NE) is a severe gastrointestinal complication in patients with hematologic malignancies undergoing chemotherapy.
- Early diagnosis and management are critical due to high morbidity and mortality.
Observation:
- Three leukemia patients presented with acute abdomen, fever, and right iliac fossa peritonitis within 14 days of chemotherapy.
- Despite antibiotics and bowel rest, all three showed a non-viable cecum requiring surgical intervention.
Findings:
- Right hemicolectomy was performed in all three cases.
- Primary ileocolic anastomosis resulted in sepsis, while staged ileostomy with delayed anastomosis led to better outcomes.
- Surgical management effectively addressed the localized septic focus.
Implications:
- Surgical intervention is crucial for managing neutropenic enterocolitis with localized peritonitis.
- Staged surgical approach may offer improved postoperative recovery compared to primary anastomosis.
- Prompt surgical management aids in controlling sepsis until bone marrow recovery.
Abstract:
Three cases of histologically confirmed neutropenic enterocolitis, each presenting as an acute abdomen in patients with leukaemia are presented. All three patients presented with fever and abdominal pain within 14 days of completing a course of chemotherapy. Signs of peritonitis localized to the right iliac fossa developed in each patient, in spite of aggressive antibiotic therapy and bowel rest. All three patients were found to have non-viable caecum at laparotomy and were treated by right hemicolectomy. Primary ileocolic anastomosis was performed in one patient, who recovered following a stormy postoperative course owing to sepsis. Two patients underwent formation of an ileostomy with distal mucous fistula and each recovered with minimal postoperative complications; secondary anastomosis was performed electively in both cases. The difficulty in diagnosing neutropenic enterocolitis preoperatively is discussed and the place of non-operative management is reviewed but we recommend surgical intervention as a means of ensuring removal of a localized septic focus until marrow regeneration occurs.