Abdominal Pain in Neutropenic Patients

Wade, David S.; Douglass, Harold O.; Nava, Hector; Piedmonte, Marion

doi:10.1001/archsurg.1990.01410210045006

Cited by 31 publications

(11 citation statements)

References 27 publications

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“…Higher rates of infectious perioperative complications are expected in neutropenic patients, and postoperative mortality rates have been reported as high as 41% [17]. Thus, a combined treatment approach was used in our patient, implementing empiric antibiotic therapy initially and delaying surgical intervention until the absolute neutrophil count reached a cutoff of 1,500 cells/μL.…”

Section: Discussionmentioning

confidence: 95%

Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review

Ali

Alhindi

Alalwan

2020

Cureus

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Acute appendicitis is a rare but important complication in children with leukemia. It can be difficult to diagnose, and it has a complicated disease course, especially in patients receiving chemotherapy. Awareness of these complications is critical, particularly in cases where surgical intervention is required. We report a child with T-cell acute lymphoblastic leukemia and chemotherapy-induced neutropenia who presented with acute appendicitis. He was successfully treated with broad-spectrum empiric antibiotics and a delayed laparoscopic appendectomy.

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Section: Discussionmentioning

confidence: 95%

Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review

Ali

Alhindi

Alalwan

2020

Cureus

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“…Cardona et al [24] reported that patients with neutrophil counts < 1000/μL had a higher risk of NE than those with counts > 1000/μL. Moreover, Wade et al [25] reported that leukocyte count recovery after the onset of NE is associated with survival. Sharma et al [30] found that 12% of the patients with epithelial ovarian cancer developed neutropenic fever while receiving first-line adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Neutropenic enterocolitis-induced sepsis and disseminated intravascular coagulation after chemotherapy: a case report

et al. 2021

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Background Neutropenic enterocolitis (NE) is a potentially life-threatening disease that primarily occurs in cancer patients treated with chemotherapy. NE has substantial morbidity and mortality, and its incidence has increased with the widespread use of chemotherapeutic agents such as taxanes, gemcitabine, and leucovorin in patients with lung, breast, gastric, and ovarian cancers. Sometimes NE can be a possible cause of death. Although, conservative approaches are often successful, there are currently no standardized treatment guidelines for NE and it is unclear when such strategies should be implemented. Therefore, we present this report to provide a greater insight into the possible treatment of NE. Case presentation We report the case of a 72-year-old woman with endometrial cancer who was undergoing treatment for hypertension, obesity and diabetes mellitus. The patient initially developed paralytic ileus on the 6th postoperative day (POD) after surgery for endometrial serous carcinoma. Complete recovery was achieved after 4 days of fasting and fluid replacement therapy. On the 27th POD, she received the first cycle of combination chemotherapy consisting of paclitaxel and carboplatin. On day 5 of chemotherapy, she developed the systemic inflammatory response syndrome including febrile neutropenia and sepsis. She then developed disseminated intravascular coagulation (DIC) and septic shock. The patient was subsequently moved to the intensive care unit (ICU). Despite initiating the standard treatment for septic shock and DIC, her overall status worsened. It was assumed that gut distention had led to bowel damage, subsequently leading to bacterial translocation. Thus, she developed NE with severe DIC and septic shock. We decided to reduce the intestinal pressure using an ileus tube to suction the additional air and fluid, even though doing so had a risk of worsening her general condition. The inflammatory reaction subsided, and her general condition improved. The patient recovered after 18 days in the ICU and was discharged alive. Conclusions Herein, we describe a patient with suspected chemotherapy-associated NE. Our observations suggest that postoperative ileus may be one of the possible causes of NE. Patients who experience postoperative ileus must be carefully monitored while undergoing chemotherapy.

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“…In our case, patients underwent abdominal CT to confirm the diagnosis. Abdominal surgery may result in significant morbidity or mortality in neutropenic patients [3][4][5]. Some authors have concluded that, if possible, the disease should be treated with intensive medical therapy rather than surgery [3].…”

Section: Discussionmentioning

confidence: 99%

“…In neutropenic patients, classical symptoms may not be present since the body may not be able to mount an adequate inflammatory response. Thus, a diagnosis of acute appendicitis may be delayed or even missed [3][4][5]. Moreover, urgent surgery may lead to high operative complications and mortality.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Acute Appendicitis in the Patients With Severe Neutropenia

Kang¹

2013

J Med Cases

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When appendicitis occurs in neutropenic adult patients, clinicians must balance the timing and the risks of surgery. Urgent surgery may lead to high operative complications and mortality. This case report details the treatment of appendicitis in neutropenic patients with hematologic disease. Patient 1 was a 31 years old female with severe aplastic anemia and patient 2 was a 34 years old male with AML M6. Both patients' abdominal CT scan was suggestive of appendicitis. We prepared supportive care first, delayed surgery was successfully completed without acute or late complications. We suggest that, in patients in a neutropenic state, delayed elective operation is superior to urgent operation, except in the case of lifethreatening complications such as peritonitis.

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Abdominal Pain in Neutropenic Patients

Cited by 31 publications

References 27 publications

Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review

Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review

Neutropenic enterocolitis-induced sepsis and disseminated intravascular coagulation after chemotherapy: a case report

Treatment of Acute Appendicitis in the Patients With Severe Neutropenia

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