Intestinal necrosis and perforation in patients receiving immunosuppressive drugs

Matolo, Nathaniel M.; Garfinkle, Sydney E.; Wolfman, Earl F.

doi:10.1016/0002-9610(76)90451-7

Cited by 42 publications

(6 citation statements)

References 4 publications

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“…Intestinal perforation in ALL patients has been widely reported, albeit most case reports and series are from the early 1970s. [12][13][14][15][16] This was an era of poor survival for ALL patients (approximately 23% survival in 1972 13 ), and where intensive chemotherapy protocols were still a work in progress. 17…”

Section: Discussionmentioning

confidence: 99%

“…No patient died due to complications associated with the intestinal perforation episode, in marked contrast to previously reported cases. 12,13,15 Although the minority of reported cases in the literature were adult patients, one should acknowledge that we are reporting cases in children, which is Early identification of the complication with appropriate surgical treatment will provide patients with good outcomes without compromising nutritional status in the long-term. In addition, treatment interruption, bridging chemotherapy, and ostomy placement did not affect survival in this limited dataset, and should be considered necessary to provide the best outcomes for these complex patients.…”

Section: Nutritional Status N (%)mentioning

confidence: 99%

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Outcomes for pediatric acute lymphoblastic leukemia patients with intestinal perforation

Canedo,

Fahy,

Krol

et al. 2024

Pediatric Blood & Cancer

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ObjectivesIntestinal perforation during acute lymphoblastic leukemia (ALL) treatment in children is rare, but represents a severe complication with possible long‐term consequences. In this study, we aim to provide an overview of the epidemiology and clinical characteristics of these patients; analyze surgical pathology findings for possible causes; and determine its impact on patients’ therapy, nutritional status, and outcome.Study designHistorical chart review from January 2000 to October 2020 of children with ALL and intestinal perforation during therapy diagnosed at a single institution. Data collected included patient demographics, anthropometric measurements, ALL characteristics, diagnosis and surgery of intestinal perforation, pathology, adjustments to treatment plan, and outcome.ResultsOf 1840 ALL patients, 13 (0.7%) presented with intestinal perforation during treatment. Perforation occurred during induction phase in 91% of cases. Most patients underwent laparotomy with ostomy creation, and no patient died from the intervention or developed malnutrition. Pathology mainly revealed inflammation at the perforation site. Two samples showed leukemic infiltration and presence of microorganisms. Patients were able to resume ALL therapy in all cases. A total of eight patients (73%) were in first remission at last follow‐up, with a median follow‐up time of 42 months (interquartile range = 42).ConclusionEarly surgical intervention is a successful treatment approach for intestinal perforation in ALL patients. There is a clear predilection for induction phase in the occurrence of intestinal perforation in ALL patients. No specific cause was identified. Patients can receive bridging chemotherapy during surgical recovery and proceed with their treatment without apparent impact on outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Nutritional Status N (%)mentioning

confidence: 99%

Outcomes for pediatric acute lymphoblastic leukemia patients with intestinal perforation

Canedo,

Fahy,

Krol

et al. 2024

Pediatric Blood & Cancer

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“…Chemotherapeutic agents themselves, as demonstrated by some researchers, can induce spontaneous gastrointestinal necrosis and even perforation ( 7,8 ) . The precise cause of the perforations remains unclear, but it may be complex.…”

Section: Discussionmentioning

confidence: 99%

Early-onset sigmoid colon perforation during concurrent chemoradiation in a patient with cervical cancer

Lin¹,

Chang²,

Huang³

et al. 2004

Int J Gynecol Cancer

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Radiation-induced colon perforation is a rare adverse effect caused by vascular and connective tissue injury to the rectosigmoid colon. It usually occurs a few months to years after radiotherapy for gynecological cancer. Herein, we present a patient who developed sigmoid colon perforation during concurrent chemoradiotherapy for cervical cancer. The patient was a 64-year-old clinical stage IIB woman who received concurrent chemoradiotherapy as a standard treatment. The chemotherapeutic protocol was cisplatin 50 mg/m(2) and 5-fluorouracil 4000 mg, starting together with radiotherapy. After the completion of external beam radiation for 4500 cGy, the patient developed sigmoid colon perforation presenting with fecal peritoneum and sepsis. An emergency end ileostomy with resection of entire sigmoid colon was performed and the patient was discharged 3 months later in good condition. Clinicians must be highly suspicious of serious bowel perforation, even if the full dose of radiation has not been completed. Whether or not the chemotherapy was the trigger factor is in need of further clarification.

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“…In those treated with the combination of idarubicin and Ara‐c, 15% develop NE 46 . The combination of 6‐thioguanine and Ara‐c may result in extensive necrosis of small and large bowel 47 . However, other factors besides chemotherapy are operative since NE can occur before chemotherapy, 48 and the chemotherapy regimen does not differ between those who do and do not develop intestinal complications 49 …”

Section: Neutropenic Enterocolitismentioning

confidence: 99%

Gastrointestinal manifestations of leukemia

Ebert

Hagspiel

2012

J of Gastro and Hepatol

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Gastrointestinal (GI) manifestations of leukemia occur in up to 25% of patients at autopsy, generally during relapse. Its presence varies with the type of leukemia and has been decreasing over time due to improved chemotherapy. Gross leukemic lesions are most common in the stomach, ileum, and proximal colon. Leukemia in the esophagus and stomach includes hemorrhagic lesions from petechiae to ulcers, leukemic infiltrates, pseudomembranous esophagitis, and fungal esophagitis. Lesions in the small and large bowel are usually hemorrhagic or infiltrative. Infiltration of lymphoreticular organs, mainly spleen, liver, and lymph nodes, is more prominent in chronic than acute leukemia. Neutropenic enterocolitis, a necrotizing process involving the cecum, ascending colon, and terminal ileum, is increasing in incidence due to greater intensity of chemotherapy. Distension of bowel leads to mucosal breaches, permitting entry of organisms that grow profusely in the absence of neutrophils. Ischemic necrosis follows, leading to perforation and/or peritonitis. Patients present with fever, abdominal pain, diarrhea, nausea, vomiting, abdominal distension and tenderness. Ultrasound and computed tomography scans show thickening of the bowel wall. Treatment is supportive with surgery for necrosis and perforation. The main GI causes of death in leukemia are hemorrhage, infection, and necrotizing enterocolitis.

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Intestinal necrosis and perforation in patients receiving immunosuppressive drugs

Cited by 42 publications

References 4 publications

Outcomes for pediatric acute lymphoblastic leukemia patients with intestinal perforation

Outcomes for pediatric acute lymphoblastic leukemia patients with intestinal perforation

Early-onset sigmoid colon perforation during concurrent chemoradiation in a patient with cervical cancer

Gastrointestinal manifestations of leukemia

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