Abstract
Neutropenic enterocolitis (NE) is a severe gastrointestinal complication in patients who undergo aggressive chemotherapy. It is a necrotizing inflammation of the cecum, colon, and the terminal part of the ileum. The serious clinical state of NE patients requires very frequent surgical consultations; however, in a few particular cases of NE, e.g., perforation of the bowels, a surgical intervention is necessary. Here, we report on six cases of NE in patients with acute leukemias. The patients were all women aged 21–55 years. Two of them had acute myeloid leukemia and four had lymphoblastic leukemia. NE occurred 7–10 days after the completion of chemotherapy, during the neutropenic phase. They represented a typical picture of NE: two of them died because of septic shock; five patients had subileus with irritation of the peritoneum; and one had hepatosplenic abscesses confirmed 6 months later by post-mortem examination. In each case, a surgical opinion was required. None of these patients were operated on. We present a report summarizing our experience and problems with six patients who had a clinical picture of NE and offer a short review of the current literature on the subject.
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Alt B, Glass NR, Sollinger H (1985) Neutropenic enterocolitis in adults: review of the literature and assessment of surgical intervention. Am J Surg 149:405–408
Avigan D, Richardson P, Elias A, Demetri G, Shapiro M, Schnipper L, Wheeler C (1998) 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 Aug 183:409–414
Baerg J, Murphy JJ, Anderson R, Magee JF (1999) Neutropenic enteropathy: a 1-year review. J Pediatr Surg 34:1068–1071
Barthey DL, Hughes WT, Parvey LS, Parham D (1982) Computed tomography of hepatic and splenic fungal abscesses in leukemic children. Pediatr Infect Dis 1:317–321
Breccia M, Girmenia C, Mecarocci S, Cartoni C, Carmosino I, Tafuri A, Alimena G (2001) Ogilvie’s syndrome in acute myeloid leukemia: pharmacological approach with neostygmine. Ann Hematol 80:614–616
Buyukasik Y, Ozcebe OI, Haznedaroglu IC, Sayinalp N, Soynalp N, Soylu AR, Ozdemir O, Dundar S (1997) Neutropenic enterocolitis in adult leukemias. Int J Hematol 66:47–55
Cartoni C, Dragoni F, Micozzi A, Pescarmona E, Mecarocci S, Chirletti P, Petti MC, Meloni G, Mandelli F (2001) Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol 19:756–761
Chubachi A, Miura I, Ohshima A, Nishinari T, Nimura T, Niitsu H, Miura AB (1994) Risk factors for hepatosplenic abscesses in patients with acute leukemia receiving empiric azole treatment. Am J Med Sci 308:309–312
Dietrich CF, Brunner V, Lembcke B (1998) Intestinal ultrasound in rare small and large intestinal disease. Z Gastroenterol 36:955–970
Ferazzi E, Toso S, Zanotti M, Giuliano G (2001) Typhlitis (neutropenic enterocolitis) after single dose of vinorelbine. Cancer Chemother Pharmacol 47:277–279
Fishmann EK, Kavuru M, Jones B, et al (1991) Pseudomembranous colitis: CT evaluation of 26 cases. Radiology 180:57–60
Gomez L, Martino R, Rolston KV (1998) Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Invest Dis 27:695–699
Gorschluter M, Glasmacher A, Hahn C, Leutner C, et al (2001) Severe abdominal infection in neutropenic patients. Cancer Invest 19:669–677
Hopkins G, Kushner JP (1983) Clostridial species in the pathogenesis of necrotizing enterocolitis in patients with neutropenia. Am J Hematol 14:289–295
Kies MS, Leudke DW, Boyd JF, McCue MJ (1979) Neutropenic enterocolitis-two case reports of long term survival following surgery. Cancer 43:730–734
Kouroussis C, Samonis G, Androulakis N, Souglakos J, Voloudaki A, Dimopoulos MA, Kotsakis T, Kakolyris S, Kalbakis K, Georgoulias V (2000) Successful conservative treatment of neutropenic enterocilitis complicating taxane-based chemotherapy: a report of five cases. Am J Clin Oncol 23:309–313
Kroniwatter U, Kemeny NE, Blumgart L (1997) Neutropenic enterocolitis in patient with colorectal carcinoma: unusual course after treatment with 5-fluorouracil and leucovorin—a case report. Cancer 80:656–660
Kulayat M, Doerr R, Ambrus J (1997) A case presentation and review of neutropenic enterocolitis. J Med 28:1–19
Moir CR, Scudamore CH, Benny WB (1986) Typhlitis: selective surgical management. Am J Surg 151:563–566
Mower WJ, Hawkins JA, Nelson EW (1986) Neutropenic enterocolitis in adults with acute leukemia. Arch Surg 121:571–574
Pastore D, Specchia G, Mele G, Montagna MT, Margari A, Carluccio P, Nacchiero M, Liso V (2002) Typhlitis complicating induction therapy in adult acute myeloid leukemia. Leuk Lymphoma 43:911–914
Sayfan J, Shoavi O, Koltun L, Benyamin N (1999) Acute abdomen caused by neutropenic enterocolitis: surgeons dilemma. Eur J Surg 165:502–504
Shamberger RC, Weinstein HJ, Delorey MJ, Levey RH (1986) The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer 57:603–609
Sloas MM, Flynn PM, Kaste SC, Patrick CC (1993) Typhlitis in children with cancer: a 30-year experience. Clin Infect Dis 17:484–490
Song HK, Kreisel D, Canter R, Krupnick AS, Stadtmauer E, Buzby G (1998) Changing presentation and management in neutropenic enterocolitis. Arch Surg 133:979–982
Stein M, Zalik M, Drumea K, et al (1995) Fatal neutropenic colitis complicating successful chemotherapy for small cell lung cancer: a case report. Isr J Med Sci 31:194–196
Verki AP, Armitage JO, Feagler JR (1979) Typhlitis in acute leukemia-successful treatment by early surgical intervention. Cancer 43:695–697
Wade DS, Nava HR, Douglass HO (1992) Neutropenic enterocolitis: clinical diagnosis and treatment. Cancer 69:17–23
Wagner ML, Rosenberg HS, Fernbach DJ, Singleton EB (1970) Typhlitis a complication of leukemia in childhood. AJR Am J Roentgenol 109:341–350
Wall SD, Jones B (1992) Gastrointestinal tract in the immunocompromised host: opportunistic infections and other complication. Radiology 85:327–335
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Wach, M., Dmoszynska, A., Wasik-Szczepanek, E. et al. Neutropenic enterocolitis: a serious complication during the treatment of acute leukemias. Ann Hematol 83, 522–526 (2004). https://doi.org/10.1007/s00277-003-0815-x
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DOI: https://doi.org/10.1007/s00277-003-0815-x