ABSTRACT
BACKGROUND AND OBJECTIVE: Neutropenic enterocolitis (NE) is a complication arising in neutropenic patients with acute leukemia or solid tumours while treated with intensive chemotherapy. The optimal therapeutic procedures have not been well established. PATIENTS AND METHOD: Seven cases of NE diagnosed and treated in a tertiary hospital between 2000 and 2007 are described. Their clinico-biological characteristics, therapeutic procedures and evolution were analysed retrospectively. RESULTS: Five of the patients were males, their median age was 39 years. Acute myeloblastic leukemia was the most frequent diagnosis (5 cases). Two other patients had received an stem cell transplantation. Abdominal pain was present in all patients, diarrhoea in 6, and fever in 5. Microorganisms were isolated from blood cultures in 4 cases (Clostridium septicum, Escherichia coli, Pseudomonas aeruginosa and Aeromonas hydrophila). Abnormal mural thickening of the caecum was observed in the 6 cases in which a computed tomography scan could be performed. The median mural thickness at its maximum section was 11 mm (range: 8-16). All patients first received medical treatment with wide spectrum antibiotics and intestinal rest, and abdominal surgery was indicated in 6 cases after a median time from first symptom of 4 days (range: 0-12). NE was confirmed histologically in all 6 patients. Five patients required admission in Intensive Care Unit and 2 (29%) died as a result of NE. CONCLUSIONS: NE is a severe complication of patients with hematologic malignancies submitted to intensive chemotherapy or receiving stem cell transplantation. Abdominal computed tomography scan is the most valuable diagnostic tool. Prompt surgical intervention may improve the prognosis in patients with NE.
Subject(s)
Enterocolitis, Neutropenic/etiology , Leukemia, Myeloid, Acute/complications , Stem Cell Transplantation/adverse effects , Abdominal Pain/etiology , Adult , Anti-Bacterial Agents/therapeutic use , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Enterocolitis, Neutropenic/chemically induced , Enterocolitis, Neutropenic/diagnostic imaging , Enterocolitis, Neutropenic/drug therapy , Enterocolitis, Neutropenic/mortality , Enterocolitis, Neutropenic/pathology , Enterocolitis, Neutropenic/surgery , Female , Humans , Intensive Care Units , Leukemia, Myeloid, Acute/drug therapy , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Fundamento y objetivo: La enterocolitis neutropénica (EN) o tiflitis es una complicación que se detecta en pacientes con granulocitopenia diagnosticados de leucemia aguda o tumores sólidos que han recibido quimioterapia intensiva. La actitud terapéutica no está bien establecida. Pacientes y método: Se describen 7 casos de EN diagnosticados y tratados en un hospital terciario entre 2000 y 2007. Se analizaron de forma retrospectiva sus características clínico-biológicas, la actitud terapéutica y la evolución clínica. Resultados: Cinco pacientes eran varones, con una edad mediana de 39 años. La leucemia mieloblástica aguda fue el diagnóstico más frecuente (5 casos). Dos pacientes eran receptores de un trasplante de progenitores hemopoyéticos en el momento de la EN. Todos los pacientes tuvieron dolor abdominal, 6 presentaron diarreas y 5, fiebre. Los hemocultivos fueron positivos en 4 casos (Clostridium septicum, Escherichia coli, Pseudomonas aeruginosa y Aeromonas hydrophila). Se detectó engrosamiento mural del ciego en la tomografía computarizada abdominal en los 6 casos en que se practicó, con una mediana del grosor mural máximo de 11 mm (extremos: 8-16 mm). Todos los pacientes recibieron tratamiento médico con antibioterapia intravenosa de amplio espectro y reposo intestinal, y 6 fueron intervenidos quirúrgicamente, con una mediana de tiempo entre el inicio del cuadro clínico y la intervención de 4 días (extremos: 0-12). Se confirmó el diagnóstico de tiflitis por estudio anatomopatológico del tejido extirpado en los 6 paciente. Cinco requirieron ingreso en la Unidad de Cuidados Intensivos y 2 (29%) fallecieron como consecuencia de la EN. Conclusiones: La EN es una complicación grave en pacientes con hemopatías malignas o receptores de un trasplante de progenitores hemopoyéticos. La tomografía computarizada abdominal es una exploración de gran ayuda diagnóstica. La intervención quirúrgica precoz puede mejorar el pronóstico de los pacientes con EN
Background and objective: Neutropenic enterocolitis (NE) is a complication arising in neutropenic patients with acute leukemia or solid tumours while treated with intensive chemotherapy. The optimal therapeutic procedures have not been well established. patients and method: Seven cases of NE diagnosed and treated in a tertiary hospital between 2000 and 2007 are described. Their clinico-biological characteristics, therapeutic procedures and evolution were analysed retrospectively. Results: Five of the patients were males, their median age was 39 years. Acute myeloblastic leukemia was the most frequent diagnosis (5 cases). Two other patients had received an stem cell transplantation. Abdominal pain was present in all patients, diarrhoea in 6, and fever in 5. Microorganisms were isolated from blood cultures in 4 cases (Clostridium septicum, Escherichia coli, Pseudomonas aeruginosa and Aeromonas hydrophila). Abnormal mural thickening of the caecum was observed in the 6 cases in which a computed tomography scan could be performed. The median mural thickness at its maximun section was 11 mm (range: 8-16). All patients first received medical treatment with wide spectrum antibiotics and intestinal rest, and abdominal surgery was indicated in 6 cases after a median time from first symptom of 4 days (range: 0-12). NE was confirmed histologically in all 6 patients. Five patients required admission in Intensive Care Unit and 2 (29%) died as a result of NE. Conclusions: NE is a severe complication of patients with hematologic malignancies submitted to intensive chemotherapy or receiving stem cell transplantation. Abdominal computed tomography scan is the most valuable diagnostic tool. Prompt surgical intervention may improve the prognosis in patients with NE
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Enterocolitis, Neutropenic/etiology , Leukemia/complications , Hematopoietic Stem Cell Transplantation/adverse effects , Retrospective Studies , Abdominal Pain/etiology , Enterocolitis, Neutropenic/therapyABSTRACT
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