Neutropenic Enterocolitis in Children with Acute Leukemia or Aplastic Anemia

Abstract

Neutropenic enterocolitis (NE) and acute appendicitis are life-threatening conditions that develop in children with severe or prolonged neutropenia secondary to acute leukemia and lymphoma. The medical records of 118 patients who were treated for acute lymphoblastic leukemia (69 patients), acute myelogenous leukemia (22 patients), or aplastic anemia (27 patients) between 1997 and 2006 in our hospital pediatric hematology department were examined retrospectively. NE was diagnosed in 11 patients (age range, 2.5–16 years) on the basis of clinical and laboratory features. Two of these 11 patients had appendicitis in addition to NE. Conservative treatment was favored for all patients, but 1 patient with acute appendicitis underwent surgery. Neutropenic patients with a hematologic malignancy and abdominal pain should receive their diagnoses immediately and undergo treatment. NE and acute appendicitis should always be considered in the differential diagnosis of abdominal pain. Conservative treatment must be choseninitially for patients with NE, and these patients should be evaluated carefully for surgery. The criteria for the surgical process are the same as those for immunocompetent children. In addition, the close monitoring of hematologic factors is necessary.

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References

  1. 1.

    Ginsburg AS, Salazar LG, True LD, Disis ML. FatalBacillus cereus sepsis following resolving neutropenic enterocolitis during the treatment of acute leukemia.Am J Hematol. 2003;72:204–208.

    Article  PubMed  Google Scholar 

  2. 2.

    Baerg J, Murphy JJ, Anderson R, Magee JF. Neutropenic enteropathy: a 10-year review.J Pediatr Surg. 1999;34:1068–1071.

    Article  PubMed  CAS  Google Scholar 

  3. 3.

    Avigan D, Richardson P, Elias A, et al. Neutropenic enterocolitis as a complication of high dose chemotherapy with stem cell rescue in patients with solid tumors: a case series with a review of the literature.Cancer. 1998;83:409–414.

    Article  PubMed  CAS  Google Scholar 

  4. 4.

    Wilson DB, Rao A, Hulbert M, et al. Neutropenic enterocolitis as a presenting complication of acute lymphoblastic leukemia: an unusual case marked by delayed perforation of the descending colon.J Pediatr Surg. 2004;39:e18-e20.

    Article  PubMed  Google Scholar 

  5. 5.

    Bavaro MF. Neutropenic enterocolitis.Curr Gastroenterol Rep. 2002;4:297–301.

    Article  PubMed  Google Scholar 

  6. 6.

    Otaibi AA, Barker C, Anderson R, Sigalet DL. Neutropenic enterocolitis (typhlitis) after pediatric bone marrow transplant.J Pediatr Surg. 2002;37:770–772.

    Article  PubMed  Google Scholar 

  7. 7.

    Smith-Slatas CL, Bourque M, Salazar JC.Clostridium septicum infections in children: a case report and review of the literature.Pediatrics.2006;117:e796-e805.

    Article  PubMed  Google Scholar 

  8. 8.

    Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia.Clin Infect Dis. 2002;34:1524–1529.

    Article  PubMed  Google Scholar 

  9. 9.

    Viscoli C, Castagnola E, Giacchino M, et al. Bloodstream infections in children with cancer: a multicentre surveillance study of the Italian Association of Paediatric Haematology and Oncology. Supportive Therapy Group-Infectious Diseases Section.Eur J Cancer. 1999;35:770–774.

    Article  PubMed  CAS  Google Scholar 

  10. 10.

    van de Wetering MD, Kuijpers TW, Taminiau JA, ten Kate FJ, Caron HN. Pseudomembranous and neutropenic enterocolitis in pediatric oncology patients.Support Care Cancer. 2003;11:581–586.

    Article  PubMed  CAS  Google Scholar 

  11. 11.

    Wehl G, Allerberger F, Heitger A, Meister B, Maurer K, Fink FM. Trends in infection morbidity in a pediatric oncology ward, 1986–1995.Med Pediatr Oncol. 1999;32:336–343.

    Article  PubMed  CAS  Google Scholar 

  12. 12.

    Dudiak KM. Abdominal case of the day: neutropenic enterocolitis associated with acute leukemia.AJR Am J Roentgenol. 1993;160:1323–1324.

    Article  PubMed  CAS  Google Scholar 

  13. 13.

    Pui CH, Boyett JM, Rivera GK, et al. Long-term results of Total Therapy studies 11,12 and 13A for childhood acute lymphoblastic leukemia at St Jude Children's Research Hospital.Leukemia. 2000;14:2286–2294.

    Article  PubMed  CAS  Google Scholar 

  14. 14.

    Schrappe M, Reiter A, Ludwig WD, et al, for the German-Austrian-Swiss ALL-BFM Study Group. Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90.Blood. 2000;95:3310–3322.

    PubMed  CAS  Google Scholar 

  15. 15.

    Creutzig U, Ritter J, Zimmermann M, et al, for the Acute Myeloid Leukemia-Berlin-Frankfurt-Münster Study Group. Improved treatment results in high-risk pediatric acute myeloid leukemia patients after intensification with high-dose cytarabine and mitoxantrone: results of Study Acute Myeloid Leukemia-Berlin-Frankfurt-Münster 93.J Clin Oncol. 2001;19:2705–2713.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. 16.

    Fleischer AC, Muhletaler CA, James AE Jr. Sonographic assessment of the bowel wall.AJR Am J Roentgenol. 1981;136:887–891.

    Article  CAS  Google Scholar 

  17. 17.

    Teefey SA, Montana MA, Goldfogel GA, Shuman WP Sonographic diagnosis of neutropenic typhlitis.AJR Am J Roentgenol. 1987;149:731–733.

    Article  CAS  Google Scholar 

  18. 18.

    Cartoni C, Dragoni F, Micozzi A, et al. Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography.J Clin Oncol. 2001;19:756–761.

    Article  CAS  Google Scholar 

  19. 19.

    Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT.Radiology. 2003;226:668–674.

    Article  Google Scholar 

  20. 20.

    Riley TV. Nosocomial diarrhoea due toClostridium difficile. Curr Opin Infect Dis. 2004;17:323–327.

    Article  PubMed  Google Scholar 

  21. 21.

    Rupnik M, Kato N, Grabnar M, Kato H. New types of toxin A-negative, toxin B-positive strains amongClostridium difficile isolates from Asia.J Clin Microbiol. 2003;41:1118–1125.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. 22.

    Johnson S, Sambol SP, Brazier JS, et al. International typing study of toxin A-negative, toxin B-positiveClostridium difficile variants.J Clin Microbiol. 2003;41:1543–1547.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. 23.

    Ozyurek E, Arda S, Ozkiraz S, Alioglu B, Arikan U, Ozbek N. Febrile neutropenia as the presenting sign of appendicitis in an adolescent with acute myelogenous leukemia.Pediatr Hematol Oncol. 2006;23:269–273.

    Article  PubMed  Google Scholar 

  24. 24.

    Moir DH, Bale PM. Necropsy findings in childhood leukaemia, emphasizing neutropenic enterocolitis and cerebral calcification.Pathology. 1976;8:247–258.

    Article  PubMed  CAS  Google Scholar 

  25. 25.

    Amromin GD, Solomon RD. Necrotizing enteropathy: a complication of treated leukemia or lymphoma patients.JAMA. 1962;182:23–29.

    Article  PubMed  CAS  Google Scholar 

  26. 26.

    Villar HV, Warneke JA, Peck MD, Durie B, Bjelland JC, Hunter TB. Role of surgical treatment in the management of complications of the gastrointestinal tract in patients with leukemia.Surg Gynecol Obstet. 1987;165:217–222.

    PubMed  CAS  Google Scholar 

  27. 27.

    Jain Y, Arya LS, Kataria R. Neutropenic enterocolitis in children with acute lymphoblastic leukemia.Pediatr Hematol Oncol. 2000;17:99–103.

    Article  PubMed  CAS  Google Scholar 

  28. 28.

    Hobson MJ, Carney DE, Molik KA, et al. Appendicitis in childhood hematologic malignancies: analysis and comparison with typhilitis.J Pediatr Surg. 2005;40:214–219.

    Article  PubMed  Google Scholar 

  29. 29.

    Angel CA, Rao BN, Wrenn E Jr, Lobe TE, Kumar AP. Acute appendicitis in children with leukemia and other malignancies: still a diagnostic dilemma.J Pediatr Surg. 1992;27:476–479.

    Article  PubMed  CAS  Google Scholar 

  30. 30.

    Wade DS, Douglass H Jr, Nava HR, Piedmonte M. Abdominal pain in neutropenic patients.Arch Surg. 1990;125:1119–1127.

    Article  PubMed  CAS  Google Scholar 

  31. 31.

    Frick MP, Maile CW, Crass JR, Goldberg ME, Delaney JP. Computed tomography of neutropenic colitis.AJR Am J Roentgenol. 1984;143:763–765.

    Article  PubMed  CAS  Google Scholar 

  32. 32.

    McCarville MB, Thompson J, Li C, et al. Significance of appendiceal thickening in association with typhlitis in pediatric oncology patients.Pediatr Radiol. 2004;34:245–249.

    Article  PubMed  Google Scholar 

  33. 33.

    Ozcay F, Kayiran SM, Ozbek N. Successful medical management of neutropenic enterocolitis (typhlitis) in a child with acute lymphoblastic leukemia.Turk J Pediatr. 2003;45:248–250.

    PubMed  Google Scholar 

  34. 34.

    Wade DS, Nava HR, Douglass HO Jr. Neutropenic enterocolitis: clinical diagnosis and treatment.Cancer. 1992;69:17–23.

    Article  PubMed  CAS  Google Scholar 

  35. 35.

    Smith TJ, Khatcheressian J, Lyman GH, et al. 2006 Update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline.J Clin Oncol. 2006;24:3187–3205.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Bulent Alioglu or Zekai Avci or Figen Ozcay or Serdar Arda or Namik Ozbek.

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Alioglu, B., Avci, Z., Ozcay, F. et al. Neutropenic Enterocolitis in Children with Acute Leukemia or Aplastic Anemia. Int J Hematol 86, 364–368 (2007). https://doi.org/10.1532/IJH97.E0739

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Key words

  • Neutropenic enterocolitis
  • Acute leukemia
  • Aplastic anemia
  • Neutropenia
  • Appendicitis