Acute Right Lower Quadrant Pain in a Patient With Leukemia

Brito, Dirk de; Barton, Erik D.; Spears, Kelvin L; Cranmer, Hilarie; Karp, Seth J.; Anglin, Deirdre; Hutson, H. Range

doi:10.1016/s0196-0644(98)70105-2

Cited by 20 publications

(9 citation statements)

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“…Sixty‐four of the 145 pertinent papers were reports of single cases (including case series in which only one patient can be assumed to suffer from neutropenic enterocolitis) (1, 17, 25–86). Thirty papers were retrospective reports of two or three cases (13, 14, 16, 87–113).…”

Section: Retrospective Reportsmentioning

confidence: 99%

Neutropenic enterocolitis in adults: systematic analysis of evidence quality

Gorschlüter

Mey

Strehl

et al. 2005

European J of Haematology

233

192

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In neutropenic patients the disease entities Ôfever of unknown originÕ (FUO) and ÔpneumoniaÕ have been clearly assessed in numerous prospective studies. Abdominal infections are less frequent but relevant life-threatening complications. Among these, neutropenic enterocolitis is the most important clinical entity, whereas cholecystitis, appendicitis and hepatolienal candidiasis are less common. Neutropenic enterocolitis occurs most frequently after intensive chemotherapy in acute leukaemias. The reported incidences of neutropenic enterocolitis in adults in the literature vary considerably from 0.8% to 26% (1, 2). Several authors observed mortality rates of 50% and higher (3-6).The practitioner, looking for good evidence facilitating his decisions concerning diagnosis and treatment of a neutropenic patient suffering from fever and abdominal pain has a difficult problem. A MEDLINE search produces numerous hits suggesting a broad data basis at the first look. However, the potential for costly time loss by disorganised searching within articles of a very low grade of evidence is great. The vast majority of the literature on this subject consists of case reports and smaller retrospective case series. A systematic review is not available.In guidelines dealing with infections in neutropenia (IDSA, DGHO and NCCN) (7-9) very few Abstract: Objective: Neutropenic enterocolitis is a life-threatening complication occurring most frequently after intensive chemotherapy in acute leukaemias. The literature is heterogenous and a systematic review is lacking. Methods: Following a systematic search we categorised all relevant reports according to their quality and extracted evidence to answer the questions: Which diagnostic criteria are appropriate? What is the incidence of neutropenic enterocolitis? Are there good quality studies supporting specific interventions: Which empiric antimicrobial therapy is recommendable? Is neutropenic enterocolitis without surgical emergency complications an indication for bowel resection? Results: We found and analysed 145 articles of these reports: 64 were reports of single cases, 30 papers reported of two or three cases, 13 were narrative reviews, 34 were retrospective case series of more than three cases and four were prospective diagnostic studies. There were no prospective trials or case control studies on the therapy of neutropenic enterocolitis. There was no consensus on diagnostic criteria. We discuss the difficulty to define diagnostic criteria without having a disease definition. Histology is mostly not available in the living patients. We suggest applying a combination of clinical and radiological criteria: fever, abdominal pain and any bowel wall thickening >4 mm detected by ultrasonography (US) or computed tomography. We calculated a pooled incidence rate from 21 studies of 5.3% (266/5058; 95% CI: 4.7%-5.9%) in patients hospitalised for haematological malignancies, for high-dose chemotherapy in solid tumours or for aplastic anaemia. Conclusions: This systematic review provides diagnostic...

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Section: Retrospective Reportsmentioning

confidence: 99%

Neutropenic enterocolitis in adults: systematic analysis of evidence quality

Gorschlüter

Mey

Strehl

et al. 2005

European J of Haematology

233

192

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“…Although most of the patients apply with typhlitis after chemotherapy, a minority of the patients apply before chemotherapy. In some patients, typhlitis can be a application reason before diagnosis [8]. Abdominal computed tomography (abdominal CT) screening is found to be effective in differential diagnosis of Tifilitis and in the direction of the therapy [3].…”

Section: Discussionmentioning

confidence: 99%

“Typhlitis” A Rare Diagnose For Emergency Room; Case Report

Güllüpınar¹

2015

Ann Clin Anal Med

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ÖzetTiflitis, çıkan kolon ve çekumun nekroz ve perforasyonu ile karakterize akut bir tablodur. Sıklıkla lösemi ve lenfoma ile ilişkili görülür. Maligniteli bir hastada, nötrope-ni, ateş, sağ alt kadranda ağrı ve hassasiyet mevcutsa ilk akla gelmesi gereken tiflitisdir. Tiflitis tanısında batın bilgisayarlı tomografisi kullanılır. Tiflitis yüksek dü-zeyde mortalite ve morbiditeyle ilişkilidir. Tiflitisin tedavisi medikal veya komplikasyonlara göre cerrahi tedavidir. Erken tanı konulmalı ve tedaviye başlanılmalı-dır. Yazımızda, acil servislerde nadir görülen bir onkolojik acil olan "Tiflitis" olgusunu sunup, tanı ve tedavi yöntemlerini literatür bilgileri eşliğinde gözden geçirdik. Anahtar KelimelerNötropeni; Karın Ağrısı; Ateş; Enterokolit; Malignite AbstractTyphlitis is an acute table that is characterised by the necrosis and perforation of the ascendant colon and cecum. It is often observed to be related to leukemia and lymphoma. If neutropenia, fever, pain in lower right quadrant and sensibility is present in a patient with malignancy, the first thing to think about is typhlitis. Abdominal computed tomography is used in the diagnosis of typhlitis.Typhlitis is related to high mortality and morbidity.The theraphy for typhlitis is medical or, depending on the complications, surgical. Diagnosis should be early and therapy should be started immediately. In our paper, we have presented the "typhlitis" case, which is an oncological emergency that is rarely observed in emergency services, and examined the diagnosis and therapy methods in the light of the relevant literature.

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“…Typhlitis (neutropenic enterocolitis or ileocaecal syndrome) is a rare but potentially life‐threatening gastrointestinal complication of neutropenia associated with malignancy [1]. It is most commonly encountered in patients with leukaemia who have recently undergone chemotherapy [2], and is characterized by transmural inflammation of the caecum, often with involvement of the ascending colon and ileum [3]. It is thought to occur because of chemotherapeutic damage to the intestinal mucosa in the context of an absolute neutropenia [1].…”

Section: Discussionmentioning

confidence: 99%

“…It is thought to occur because of chemotherapeutic damage to the intestinal mucosa in the context of an absolute neutropenia [1]. It presents clinically with fever, abdominal pain and diarrhoea [2], with radiographical evidence of colonic inflammation [4]. Clinical management remains controversial [5] with conservative medical measures holding predominance and surgical intervention reserved for specific complications [4].…”

Section: Discussionmentioning

confidence: 99%