A case presentation and review of neutropenic enterocolitis

Neutropenic enterocolitis (NE) is an unusual complication of neutropenia. Its presentation is dramatic, treatment is controversial, and the outcome may be devastating. The available literature about this entity is mainly case reports and autopsy studies. We have recently performed a celiotomy on a patient who developed sepsis and an acute surgical abdomen three days following chemotherapy and radiotherapy for a metastatic adenocarcinoma with no known primary tumor. At surgery he was found to have a boggy right and recto-sigmoid colon with a grossly normal transverse colon. Intraoperative colonoscopy revealed mucosal ulceration and necrosis extending from the dentate line to the cecum. A total abdominal colectomy, closure of the rectal stump, and an ileostomy was performed. Postoperatively, the patient recovered from the abdominal septic process only to succumb to multiple system organ failure secondary to pulmonary sepsis. Upon review of the literature, we found 65 cases of NE that were suspected or diagnosed in the antemortem state and confirmed at surgery or autopsy. In this review, we intend to analyze these case reports, summarize the salient features of the disease and outline the optimal therapeutic approach.