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The first patient, a 68-year-old woman, presented neutropenic fever and hemorrhagic diarrhea on the sixth day of a combination chemotherapy of carboplatin and paclitaxel. The second patient, a 30-year-old man, presented neutropenia and diarrhea on the tenth day of the second cycle of a combination chemotherapy of cisplatin and vinorelbine. In both patients, abdominal computed tomography scan showed thickening of the colon wall and pericolic edema, and the ultrasonography revealed echogenic thickening of the colon walls. These findings confirmed the diagnosis of neutropenic enterocolitis. After the treatments, we changed the anticancer drug regimen; and successfully achieved partial responses.

Neutropenic enterocolitis (NE) is an unusual acute complication of neutropenia, most often associated with leukemia and lymphoma which is characterized by segmental cecal and ascending colon ulceration that may progress to necrosis, perforation, and septicemia. We present a case of neutropenic enterocolitis in a patient with non-small-cell lung cancer who received docetaxel and flavopiridol as part of a phase I clinical trial and review cases in the literature where docetaxel was involved. Given the increased use of docetaxel and other taxanes in the treatment of advanced lung cancer, physicians should be aware of this potential toxicity of therapy.

The patient is a 44-year-old woman with metastatic grade 3 intra-ductal carcinoma of the breast who was started on palliative chemotherapy (docetaxel) 10 days prior to admission and presented to the emergency center complaining of diffuse abdominal pain and generalized weakness. CT abdomen showed diffuse bowel wall thickening from the cecum to the transverse colon with free fluid in the pelvis. The patient was neutropenic on admission (absolute neutrophil count of 600 cells/μl). She received antibiotics for 21 days for neutropenic enterocolitis. Blood culture isolate from admission was sent for 16s rRNA gene sequencing, which identified Clostridium chauvoei. While C. chauvoei has a long history of veterinary importance, this is the first documented case of infection caused by C. chauvoei in a human in the United States. C. chauvoei has a close phylogenetic relationship with C. septicum making the two species difficult to differentiate using conventional microbiologic methods. With increased use of more reliable detection methods the actual prevalence of C. chauvoei causing human disease may be higher than currently recognized.

NE (typhlitis) is a potentially life-threatening disease process characterized by bowel wall edema, ulceration, and hemorrhage in an immunosuppressed patient. We report a 15-year-old boy status post deceased donor renal transplantation who presented with fever, abdominal pain, and diarrhea. Laboratory studies revealed neutropenia 5 days prior to admission, and abdominal computed tomography revealed bowel wall thickening in the cecum consistent with NE. He was treated with piperacillin-tazobactam and gentamicin and recovered. To our knowledge, this is the first report of a case of NE in a pediatric kidney transplant recipient.

Neutropenic colitis is a severe condition usually affecting immunocompromised patients. Its exact pathogenesis is not completely understood. The main elements in disease onset appear to be intestinal mucosal injury together with neutropenia and the weakened immune system of the afflicted patients. These initial conditions lead to intestinal edema, engorged vessels, and a disrupted mucosal surface, which becomes more vulnerable to bacterial intramural invasion. Chemotherapeutic agents can cause direct mucosal injury (mucositis) or can predispose to distension and necrosis, thereby altering intestinal motility. This article aims to review current concepts regarding neutropenic colitis’ pathogenesis, diagnosis, and management.

Here we report a case of a 59-year-old man who developed neutropenic enterocolitis(NE)after autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma in his second complete remission.Four days after transplantation, the patient suffered from diarrhea, abdominal pain, fever, and paralytic ileus.Abdominal computerized tomography scan revealed bowel wall thickening consistent with NE.Owing to his poor performance status, only medical management, including antibiotics and bowel rest, was administered, and the patient died 18 days after transplantation.Although NE after autologous peripheral blood stem cell transplantation is a relatively rare complication, it is important to be aware that this condition can occur as one of the early complications in stem cell transplantation.

to determine the prevalence of opportunistic microorganisms and microbial flora in neutropenic enterocolitis in oncohematological pediatric patients.a prospective and observational study was done. Patients with diagnosis of acute leukemia and neutropenia were included. Stool cultures were taken to identify microorganisms and microbial flora. A χ(2) test with Yates corrections and Fisher exact test were used in the statistical analysis.21 patients were included (12 male, 57.1 %). The stool cultures showed that 68 % of microorganisms were Gram-negative. The presence of microorganisms Gram-positive was 20 %, 6 % for Candida sp.; 3 % for Cryptosporidium sp.; and in 3 % were acid fast bacilli. Staphylococcus epidermidis, Enterobacter sp., and Escherichia coli were presented in pure culture. No association was found between Gram-positive and Gram-negative microorganisms with age, white cell count or pure or mixed cultures.although Gram-negative microorganisms were the most frequent, Gram-positive and other microorganisms that are not detected habitually in feces culture were isolated.Objetivo: determinar la microbiota y la prevalencia de microorganismos oportunistas en niños con leucemia y enterocolitis neutropénica. Métodos: se realizó un estudio prospectivo observacional en pacientes con leucemia aguda y neutropenia. Se tomaron cultivos de heces para identificar la presencia de bacterias y microbiota. Se aplicó estadística descriptiva para su análisis. Resultados: fueron incluidos 21 pacientes (12 hombres, 57.1 %). En 68 % de los coprocultivos se observó desarrollo de microorganismos gramnegativos. La presencia de microorganismos grampositivos fue de 20 %, 6 % de Candida sp., 3 % de Cryptosporidium sp. y en 3 % se observaron bacilos ácido alcohol resistentes. Staphylococcus epidermidis, Enterobacter sp., y Escherichia coli se observaron en cultivo puro. No se encontró asociación entre microorganismos grampositivos y gramnegativos con la edad, el recuento leucocitario ni el cultivo puro o mixto.Conclusiones: aunque los microorganismos gramnegativos fueron los más frecuentes, se aislaron de manera importante grampositivos y otros que no se buscan de rutina en el coprocultivo.

Neutropenia is a common toxicity of systemic cytotoxic therapy. Neutropenic enterocolitis (NE) is a rare occurrence but can be fatal, subsequent to neutropenia. The exact incidence and frequency is difficult to establish, but is usually underestimated. It is often missed but has recently been appreciated with increasing frequency in solid tumours. NE was initially reported with taxenes but now an increasing number of chemotherapeutic drugs are implicated. NE incidence is expected to increase with the use of dose dense regimens, myeloablative cytotoxic protocols, tissue transplants, and emerging newer molecules. The usual presentation is often non-specific and often over shadowed by the symptomatology of primary malignant disease and toxicity symptoms of chemotherapy. The basis of diagnosis is clinical, radiological (ultra sound/CT scan), per operative findings, and eventually post mortem. Treatment options of this highly fatal phenomenon varies from conservative to early surgical intervention. NE is expected to be diagnosed with increasing frequency. The factors leading to it are mucosal injury, caecal distension with resultant ischaemia, cytotoxic drugs, and microbiological agents. A high index of clinical suspicion and an early diagnosis is paramount for better outcome. Irrespective of management employed, conservative or upfront surgical intervention, it has a poor out come with high mortality. A clinical suspicion, early diagnosis, and prompt management are the key to a better result. There is need to identify people at high risk by prognostic factors, large scale studies, and formulating consensus management guidelines. At present individualized risk assessment based strategy is advocated.

Neutropenic enterocolitis (NE) is a life-threatening complication most commonly seen in patients receiving intensive chemotherapy for acute leukemia. The condition usually affects the terminal ileum, cecum, or ascending colon. In rare instances, NE may occur before the initiation of chemotherapy or involve more distal bowel. The authors report the case of a 2-year-old girl who had NE affecting the descending colon as a presenting complication of acute lymphoblastic leukemia. Despite aggressive medical interventions, including granulocyte infusions, she had a delayed bowel perforation that was managed successfully with surgery. This case highlights the challenges of treating patients who have NE as an initial manifestation of acute leukemia.

Management of an 8-year-old boy with Hodgkin lymphoma is presented. The patient had several recurrences of neutropenic enterocolitis and eventually required ileocecectomy. A review of the literature on this difficult problem affecting pediatric oncology patients is presented.

We report the case of a 27-month-old male with an unusual complication of aplastic anaemia and neutropenic enterocolitis. He suffered persistent neutropaenic sepsis and clinical deterioration forced the strategy of matched sibling haematopoietic stem cell transplantation. With engraftment and clinical recovery post-transplant, enteral feeding was re-established. Despite continued improvement the child began to vomit faeculent stomach content. Barium swallow showed gastro-colic and gastro-enteric fistulisation with contrast passing directly from stomach into descending colon and directly into jejunum. Laparotomy confirmed complex fistulae between the gastric body, the splenic flexure of the colon and the jejunum. The diagnosis and management of abdominal pathology secondary to severe pancytopaenia is challenging. Often the patient does not manifest the usual signs of acute abdominal pathology, making the decision to operate and the timing of surgery difficult. Counfounding this is the danger of performing surgery in a pancytopaenic patient. Our case illustrates these challenges and reports the unanticipated finding of a complex gastro-colic fistula.

Background Neutropenic enterocolitis (NE) is a life-threatening complication occurring after intensive chemotherapy; however, no data are available on NE development after hematopoietic stem cell transplantation (SCT). The aim of this study was to determine the incidence, risk factors, and outcome of NE after high-dose chemotherapy and autologous SCT (autoSCT). Methods A total of 297 adult patients who qualified for autoSCT with non-Hodgkin's lymphoma (NHL), Hodgkin's disease, multiple myeloma, and acute myeloid leukemia were analyzed. Patients were conditioned with carmustine, etoposide, cytarabine, melphalan (BEAM); melphalan alone; or busulfan and cyclophosphamide (BuCy2), and transplanted with peripheral blood or bone marrow CD34+ cells. Diagnosis of NE was established in case of neutropenic fever, abdominal pain or diarrhea, and bowel wall thickening >4 mm on abdominal sonography. Results Neutropenic infections occurred in 262 patients (88%). NE was diagnosed in 32 patients (12%), a median +3 (1-5) days after SCT. Bloodstream infections were present in 18 patients, with gram-negative bacteria in 11 patients. All patients were treated conservatively with carbapenems and total parenteral nutrition with bowel rest. The course of disease was complicated by ileus or septic shock in 9 patients, and was fatal for 3 (9.6%) patients. In univariate analysis, the initial diagnosis of NHL (P = 0.017) and conditioning with BEAM (P = 0.043) had prognostic value. In multivariate analysis, only initial diagnosis of NHL (P = 0.017) had prognostic significance. Conclusions NE is a rare but severe complication in patients undergoing autoSCT. Gram-negative bacteria remain the main causative pathogen. Abdominal sonography allows early diagnosis and treatment, effective in most of patients without surgery. In our analysis, NE was seen more often in NHL patients treated with a BEAM regimen.

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.

To describe the symptoms, clinical management and short-term outcome in a series of paediatric oncology patients with severe typhlitis following conservative treatment.Twelve episodes of severe typhlitis in 11 children with cancer treated at the paediatric oncology ward at Queen Silvias Children's Hospital between 1995 and 2006 were analysed retrospectively. Data on symptoms, radiological findings, laboratory status and treatment as well as outcome were collected and analysed.In all episodes, the classical signs of neutropenia, fever, abdominal pain and thickening of the bowel wall were present. All were successfully treated with bowel rest, broadspectrum antibiotics and supportive care. After recovery from typhlitis, three patients needed surgical intervention because of complications.A high clinical suspicion combined with radiological imaging aids early diagnosis. Predisposing factors for developing typhlitis were haematologic malignancy and treatment with chemotherapy within 3 weeks of onset. Supportive care, bowel rest including parenteral nutrition, correction of cytopenias and aggressive antimicrobial treatment is essential. Measurements of C-reactive protein in blood may be of benefit when assessing the clinical course.

Neutropenic enterocolitis (NE) is clinically defined by the triad of neutropenia, abdominal pain and fever. This retrospective study is to review 24 cases of NE in a single Chinese tertiary center, to elucidate clinical feature, treatments and outcome for this dangerous gastrointestinal complication of neutropenia.The medical records of pediatric patients who were diagnosed with neutropenic enterocolitis from 2000 to 2009 were reviewed.Of 24 cases, the ratio of male to female was 2:1, the mean age was 7.2 years. There were eight cases of acute lymphocytic leukemia, eight cases of acute non-lymphocytic leukemia, four cases of non-Hodgkin's lymphoma, one case of severe aplastic anemia, one case of neuroblastoma and two cases of simple neutropenia without underlying cause. The hematologic malignancy was significantly associated with the occurrence of NE (OR = 19.4). Seventeen cases developed NE during anticancer chemotherapy (chemo group), four cases presented with leukemia and one case presented with aplastic anemia before the initiation of chemotherapy and their presenting event leading to diagnosis. Two cases simply presented with NE without definitive reasons (no chemo group). All the patients had the typical clinical presentation, six cases had disseminated peritonitis, toxic shock, and assisted ventilations were necessary in three of these six cases. CT or ultrasound demonstrated bowel wall thickness, paucity of air in the cecum and/or right colon, pneumatosis or pneumoperitoneum. There was no difference in the nadir neutrophil count in patients, who received chemotherapy versus those who did not (P = 0.001), but the recovering time from NE in chemo group (9.3 ± 1.9) was shorter than non-chemo group (10.7 ± 5.3, P = 0.034). Sixteen (88.8%) cases have been successfully managed medically, using aggressive hemodynamic support, bowel rest, and broad-spectrum antibiotic therapy with surgical intervention reversed only for the more severe six cases (25%). Two cases died.NE is a life-threatening gastrointestinal complication of neutropenia. Physicians might remain vigilant and consider NE in any neutropenic patient rather than only in oncologic patients. It has typical clinical presentation and CT can provide clear delineation for diagnosis. Early recognition and progressed management have reduced mortality. Most children with NE may be treated without surgery with favorable outcome.

Neutropenic enterocolitis is a common gastrointestinal complication in children undergoing chemotherapy for a variety of malignancies. It usually involves ileum and caecum, and involvement of rectum has rarely been reported. The authors report neutropenic enterocolitis in a child undergoing chemotherapy for acute lymphoblastic lymphoma which presented with ileus along with a mass like lesion in the rectum.

Neutropenic enterocolitis is a life-threatening complication that usually occurs in connection with chemotherapy for acute leukemias. Our experience with diagnosis and treatment of these patients is presented.Medical records from patients treated for neutropenic enterocolitis at Ullevaal University Hospital in the period 2000-2008 were retrospectively reviewed.16 patients with median age 33 years were treated for neutropenic enterocolitis. Induction chemotherapy was given for acute myelogenic (n = 9) or lymphatic (n = 4) leukemia, myelomatosis (n = 2) or lymphoma (n = 1). The patients developed aplasia five days (median) after start of chemotherapy. All patients were first treated conservatively with broad-spectrum antibiotics, fluids and electrolyte supplementation; nine of them recovered without complications. Four underwent surgery for perforation or ileus and these had the longest period with aplasia (median 31 days). Surgery for perforation is mainly limited resection and construction of ileostomy reservoirs (one or two). Three patients died. These were only treated conservatively; aplasia occurred quicker in these patients (after median two days) and they had the largest number of affected bowel segments (median nine).Neutropenic enterocolitis is a heterogeneous condition and the treatment is mainly conservative. Surgical intervention is mandatory in patients with free intraabdominal air, ileus and intractable intestinal bleeding. The prognosis seems to worsen when aplasia develops after a short time and when there is a large number of affected bowel segments.

Transabdominal ultrasound is most commonly used to examine the liver, hepatobiliary-pancreatic and urogenital tract. Its use for imaging the intestinal tract is less well established and has been considered more difficult in the past. Improvements in technology and increasing experience with sonographic findings in a variety of intestinal diseases including inflammatory bowel disease (IBD), however, have contributed to firmly establishing the role of ultrasound as a clinically important, non-invasive and widely available imaging modality. In addition, newer techniques such as harmonic imaging and contrast-enhanced ultrasound have recently gained attention. Transabdominal ultrasound is clinically useful in the initial diagnosis of IBD by evaluating bowel wall thickness and surrounding structures including peri-intestinal inflammatory reaction, extent and localization of involved bowel segments and detection of extraluminal complications such as fistula, abscesses, carcinoma and ileus. Transabdominal ultrasound is currently accepted as a clinically important first-line tool in assessing patients with Crohn’s disease irrespective of their clinical symptoms and/or disease activity. It helps to better characterize the course of the disease in individual patients and can guide therapeutic decisions. The topic of this review is to provide an updated overview of the role of transabdominal ultrasound in IBD including Crohn’s disease, ulcerative colitis, tuberculosis and neutropenic colitis while summarizing the results of recent studies with special reference to sensitivity/specificity in detecting the disease and sonomorphologic features to evaluate disease activity and its luminal and extraluminal complications.

Neutropenic enterocolitis (NEC) is characterized by inflammatory damage and necrosis of the intestinal mucosa, mainly of the terminal ileum and the cecum. It is more frequent in patients with leukemia and/or undergoing antineoplastic chemotherapy, and the main risk factor is neutropenia1000/mm3.To know the prevalence of NEC and the mortality associated with it in adults with hematologic conditions and neutropenia1000/mm3.All adult patients who were hospitalized for malignant hematologic conditions with neutropenia1000/mm3 were enrolled in the study; those with neutropenia1000/mm3 were excluded. The diagnosis of NEC was based on the clinical data and imaging tests (abdominal plain X-rays and CT scan). Demographics of all patients were collected, as well as the data related with the course and treatment of the underlying hematologic condition and the NEC.117 patients were enrolled in the study; 75.2% of them with some type of acute leukemia. The diagnosis of NEC was made in 8 patients (6.8%). NEC occurred in 10.5% of the patients with acute myeloid leukemia and in 8.0% of those with acute lymphocytic leukemia. Three patients died, which resulted in a 37.5% mortality rate. No association was found between the severity of neutropenia and the onset of NEC or NEC-related mortality.The prevalence of NEC in patients with hematologic conditions admitted for severe neutropenia is 6.8% and the mortality rate associated with this complication is 37.5%.

Gastrointestinal bleeding is a common occurrence in patients with cancer and is a frequent indicator of a gastrointestinal malignancy. Rapid evaluation and treatment is key for the hemodynamically unstable patient. Endoscopy remains the cornerstone of diagnosis and management for cancer patients with gastrointestinal bleeding. The emergency physician should also be aware of other diagnostic and treatment modalities that may be needed to take care of these patients.

Neutropenic enterocolitis (NEC) also known as typhlitis is an acute, life-threatening inflammation of the small and large bowel often seen in patients with leukaemia undergoing cytotoxic chemotherapy: occasionally this syndrome could present in other immunocompromised patients.To report an unusual case of Fanconi anemia complicated by neutropenic enterocolitis.We report a case of a 13-year-old boy affected by Fanconi anemia with severe neutropenia and who presented neutropenic enterocolitis. Abdominal ultrasonography showed thickening of cecum and ascending colon of 1.18cm. The outcome was favourable with medical management.Neutropenic enterocolitis in Fanconi anemia is a rare and a severe illness: however, the outcome is improved with early management.

Gastrointestinal complications of chemotherapy may be serious and potentially life-threatening. Familiarity with and awareness of the potential complications associated with various chemotherapeutic agents/regimens is paramount to enable accurate and timely diagnosis. In this article we review the radiological manifestations of the most notable gastrointestinal complications associated with chemotherapeutic administration.

Purpose of review This review highlights recent updates in cytotoxic treatment-induced gastrointestinal symptoms and complications, outlines the development of new diagnostic tools, and offers an up-to-date overview on management. Recent findings The neurokinin-1 receptor antagonist, aprepitant, has consolidated its attributive role in the prevention of acute phase chemotherapy-induced nausea and vomiting. Delayed gastrointestinal symptomatology related to the process of cytotoxic treatment-induced mucosal damage needs to be better understood in order to enable the clinician to assess gastrointestinal mucosal damage properly by documenting symptomatology, testing functionality and visualizing anatomical changes. By contrast to the proven beneficial effects of new drugs, such as palifermin (a trophic epidermal growth factor) or amifostine (free radical scavenger), in the management of oral mucositis, efficacy still needs to be determined regarding its gastrointestinal counterpart. Summary Gastrointestinal symptoms originating from cytotoxic treatment-induced mucosal barrier injury are the clinical features of a complex, dynamic pathobiological process that diminishes the quality of life but, more importantly, places the patient at risk for serious complications, like neutropenic enterocolitis. It is crucial, therefore, to adequately detect mucosal barrier injury using a complementary approach that will allow new therapeutic options to be tested thoroughly and improve supportive care.

A spectrum of oncologic treatments including chemotherapy, radiotherapy, and molecular targeted therapies is available to combat cancer. These treatments are associated with adverse effects in several organ systems including the gastrointestinal (GI) tract. Any part of the GI tract can be affected including the upper GI tract (esophagitis due to bacterial, viral, and fungal infections; mucositis due to chemotherapy or radiation; GI bleeding; nausea and vomiting), colon (diarrhea, graft-vs-host disease [GVHD], and constipation), liver (drug toxicity and GVHD), and pancreas (pancreatitis). Adverse effects range from mild to life threatening. The primary goal of cancer treatment is to administer the most effective therapy while minimizing potential toxicity. This review discusses common GI complications that can result from cancer therapy. The pathologic mechanisms underlying each complication and the pharmacology of the agents used to treat these complications are discussed.

Recent advances in transplantation, oncology and AIDS therapy have greatly increased life expectancies of patients diagnosed with malignancy, auto-immune disorders and organ failure. However, as this immune compromised population grows, complications of such therapies have become a major source of morbidity and mortality. Classical clinical and laboratory evidence of intra-abdominal pathology may be absent in the immune compromised host. Consequently, the radiologist is increasingly called upon to diagnose acute intra-abdominal complications associated with immunodeficiency. This review explores the aetiology of the acute abdomen in the immune compromised host. The typical radiological appearances of the commonest conditions are illustrated. The challenges and limitations in the radiological diagnosis of these conditions are discussed.

A 30-year-old man with a history of transfusion–dependent anemia presented with 2 days of rectal bleeding. Physical examination revealed vague tenderness in the lower quadrants of the abdomen. Complete blood count showed a white blood count of 2000/mm (normal 4000-10,000/mm), a hemoglobin level of 7.1 g/dL (13.018.0 g/dL), and a platelet concentration of 14,000/mm (150,000-400,000/mm). On colonoscopy, bleeding was found from multiple polypoid and fungiform lesions in the rectum (A) and cecum (B). Lesions were variable in size, ranging from 0.5 to 1.5 cm, friable, and covered with exudate. Some had superficial ulcerations from which blood oozed. CT scan of the abdomen showed circumferential and diffuse colonic bowel wall thickening in a layered pattern in the rectum and cecum (C). Histology showed superficial ulcers with submucosal edema, hemorrhage, and lymphocytic infiltrates without any neoplastic component (D, H&E, orig. mag. 400). Studies for microorganisms were negative from both tissue and blood. Anemia accompanied by leucopenia and thrombocytopenia eventually proved to be from aplastic anemia

Neutropenic enterocolitis is a severe and potentially life-threatening complication that may affect patients undergoing chemotherapy for acute leukemia or lymphoma. These patients may develop systemic sepsis through bacterial or fungal translocation across the intestinal wall. In many cases neutropenic enterocolitis is confined to the cecum, but the entire colon is sometimes involved. Most patients are treated conservatively because an improvement occurs when the absolute neutrophil count rises. However, a surgical approach consisting of resection of the colon may sometimes be necessary, even in patients with complete aplasia and a high risk of complications. The right time to perform surgery is hard to define. Intestinal wall thickness, evaluated by ultrasound, is an important prognostic factor which could act as a guide to surgical indication. We analyze a case of neutropenic enterocolitis which occurred in a patient with acute myeloid leukemia during chemotherapy and we suggest that, as well as intestinal wall thickness, hemodynamic worsening should be considered an indication for surgery.

Neutropenic enterocolitis or typhlitis (from the Greek typhlon, meaning caecum) is defined as a necrotizing colitis with inflammation of the cecum and surrounding tissues. Although this condition occurs primarily in severely myelosuppressed and immunosuppressed patients with leukemia, it may also occur in those with other advanced malignancies receiving myelosuppressive chemotherapy. It has been described most recently in patients with solid tumors who receive taxane-based therapy. A 60-year old woman with medullary breast cancer stage IIIB underwent neoadjuvant chemotherapy with TAC (doxetaxele 100 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 600 mg/m2). Sixth day after TAC chemotherapy, she had abdominal pain and vomiting. Abdomen CT scan showed diffuse circumferential thickening of ileum wall typical for ileitis, narrowing of the lumen, disturbance of peristaltic. This abdomen CT scan was thought as abnormality pictures of neutropenic enterocolitis. Neutropenic enterocolitis should be considered in patients with abdominal symptoms especially during the granulocyte nadir following chemotherapy. Increased awareness of this rapidly progressive and potentially fatal disease leads to accurate diagnosis and the prompt treatment that can decrease morbidity and mortality.

We report a case of neutropenic enterocolitis diagnosed on computerized tomography abdomen in a 56-year-old man having high-grade non-Hodgkin's lymphoma. After appropriate management, the patient recovered completely.

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.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.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.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.

AIM: To investigate the sonographic features at time of diagnosis and follow-up in patients with neutropenic enterocolitis. METHODS: The sonographic findings in 14 patients with neutropenic enterocolitis were described and evaluated regarding symptoms and clinical outcome. RESULTS: In all patients with neutropenic enterocolitis, the ileocoecal region was involved with wall thickening >10 mm. A transmural inflammatory pattern, hypervascularity of the thickened bowel wall and free abdominal fluid were the common findings. The sonographically revealed thickness of the bowel wall was associated with lethal outcome (P

Isolated edematous swelling of Bauhin's valve is a rare finding in cases of non-specific abdominal complaints in the lower right abdominal quadrant. The differential diagnosis includes entities such as tumours, chronic gastrointestinal inflammation and ileocoecal intussusception as well as specific infections, all of which require individual therapy. Based on two current cases and a review of the literature, aetiology, clinical picture and diagnostic findings of isolated edema of the ileocoecal valve are described. The typical ultrasound findings are presented. Due to its potential of excluding other diseases, modern ultrasound offers promising results in the case of isolated edematous swelling of Bauhin's valve.

Literature data show that neutropenic enterocolitis is a rare but severe complication that can occur in cancer patients treated with chemotherapy and especially with taxanes.A 60-year-old woman with stage Illc epithelial ovarian cancer developed neutropenic fever, abdominal pain, severe diarrhoea, nausea, vomiting and oral mucositis one week after the first postoperative cycle of paclitaxel (175 mg/m2 3-hour infusion) plus carboplatin-based chemotherapy. Abdominal X-ray showed diffuse dilatation of the ileal and colonic loops with air/fluid. The patient soon recovered after intensive supportive care. For the second cycle the dose of paclitaxel was reduced by 20%, but nine days later the patient again developed severe neutropenia with fever, abdominal colicky pain, diarrhoea and vomiting. The culture of blood samples collected on admission was found to be positive for Escherichia coli, whereas stools resulted negative for both enteric rods and Clostridium difficile toxin. The patient recovered with intensive supportive care, and chemotherapy was continued with single-agent carboplatin.The increasing use of paclitaxel in first-line as well as in the salvage treatment of epithelial ovarian cancer could increase the occurrence of neutropenic enterocolitis in patients with this malignancy. The importance of symptoms such as neutropenic fever, abdominal pain and tenderness and severe diarrhoea should be stressed in patients who receive taxane-based chemotherapy, and intensive supportive care management should be started immediately.

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 criteria for neutropenic enterocolitis, presents a quantitative synthesis on its incidence and discusses its treatment recommendations. Prospective studies are clearly warranted.

Background/Purpose Recognition of appendicitis in the child with hematologic malignancy may be difficult particularly in the setting of neutropenia and multiple medications causing an altered inflammatory response. Typhilitis may produce a similar constellation of clinical findings causing further diagnostic confusion. This review compares the relative frequency of these two conditions in children with hematologic malignancy with a focus on the clinical presentation, distinguishing features, surgical management, and outcome for patients with appendicitis. Methods This institutional review board–approved retrospective study evaluated 464 pediatric patients treated for hematologic malignancy at our institution from 1997 to 2003. From this cohort, we identified all children with a diagnosis of appendicitis or typhilitis. Data include demographics, clinical presentation, laboratory studies, and computed tomography (CT) scan findings. Groups were compared using the Fisher exact test. Significance was defined as P Results Eight (1.7%) of 464 children were diagnosed with typhilitis and 7 (1.5%) with appendicitis. There were no demographic differences between patients with appendicitis and typhilitis. Distinguishing clinical features in children with typhilitis included presence of fever and diarrhea. Clinical presentation in children with appendicitis was atypical in 5 of 7 cases yielding an incorrect preoperative diagnosis in all 5. Radiographic evaluation by CT scan accurately defined typhilitis, but not appendicitis. An operation was performed on all 7 children with appendicitis with no operative morbidity or mortality. Conclusions Appendicitis and typhilitis occur with similar frequency in children with leukemia and lymphoma. Typhilitis is accurately diagnosed with clinical findings of fever, diarrhea, abdominal pain, and typical CT scan findings. Appendicitis tends to present with atypical findings, but can be successfully managed with standard surgical care.

Neutropenic enteropathy (NE) is used to describe the inflammation of the bowel in neutropenic patients under aggressive chemotherapy, mainly for lymphoproliferative and hematologic malignancies. Surgical intervention may be required in patients with the advent of the disease. We report our experience in 7 children with NE who had to be treated surgically. Absolute neutrophil counts were less than 1000/mm3 in all, with positive blood cultures in five patients. Four patients recovered with rapid resolution of neutropenia, while three patients died with persistent neutropenia.

In this report we focus on the importance of an accurate diagnosis of gastrointestinal complications during chemotherapy for acute myeloid leukemia. The leukemic infiltrtion of the digestive system may cause mucosal ulcers which can lead to bleeding or perforation. The immune system deficiency in this cohort of patients may result in necrotic enterocolitis (leukemic typhlitis), perianal inflammation, abscesses, and peritonitis. We describe a 37-year old male who presented in June 2004 with 2-month history of fever, weakness and sore throat, treated with antibiotic therapy. Physical examination demonstrated palor. The peripheral blood count at admittance was as follow: Hemoglobin 87 g/l, WBC 63 x 10(9)/l, and platelets 56 x 10(9)/l. The peripheral blood differential count showed: myeloblasts 4%, polymorphonuclear neutrophils (PMN) 20%, monocytes 60%, lymphocytes 16%. The diagnosis of acute myeloid leukemia (AML) was confirmed by bone marrow aspirate, which presented an almost total infiltration by monocytoid blasts, AML type M5 according to FAB classification. Immunophenotypic evaluation by flow cytometry showed that the blast cells reacted with antibodies to CD33, CD13, CD14, CD64, CD15, cytogenetics showed normal karyotype. Induction treatment consisting of cytarabine 2 x 200 mg intravenously in push on days 1-8, vepeside 200 mg i.v. on days 1-5, adriblastine 90 mgon days 1,3 and 5. On day 15 of chemotherapy the patient got fever 38.5 degrees C, abdominal pain and diarrhea (10 stools daily). Broad-spectrum antibiotic therapy with ceftriaxone and amikacin was promptly instituted but condition worsened, abdominal pain extended to all abdomen while the fever and diarrhea persisted. Ultrasonography on day 18 documented bowel wall thickness of colic tract, part of duodenum and jejunum. Owing to suspicion of neutropenic enterocolitis, antibiotic therapy intensified with teicoplanin, fluconazole, metronidazole and pipril. Patient was neutropenic and thrombocytopenic, although daily platelet transfusion from a single donor were given. We started with granulocyte colony stimulating factor (G-CSF) 5 g/kg, which was adiminstered for 7 days. After 7 days neutrophil value reached 1 x 10(9)/l, but fever persisted, abdominal distension and diarrhea progressively improved. The fever peristed and central venous catheter was removed on day 30. After removal of the catheter the patient was getting better: the fever disappeared. The blood count showed Hb 91 g/l, WBC 3,4 x 10(9)/l, platelet 114 x 10(9)/l and normal leukocyte differential count. We emphesize the importance of collaboration between the hematologist and the surgeon in monitoring gastrointestinal complications during and after chemotherapy for acute leukemias and value of abdominal ultrasonography evaluation.

Neutropenic enterocolitis (NE) is an unusual acute complication of neutropenia, associated with leukemia and lymphoma. It has been observed mainly in the first phase of therapy when drugs are used in maximally tolerated dose. This is a case report of neutropenic enterocolitis in a patient with acute lymphoblast leukemia who received prednisone, vincristine, daunorubicin and L-asparaginase, with perforation of cecal and terminal ileum. Perforation and defect intestine wall was excised and sutured directly in two layers. Protective proximal loop ileostomy was performed at that time.

This study describes the clinical, epidemiological and microbiological characteristics of adult patients with blood cancer and neutropenic enterocolitis treated in the Instituto Nacional de Cancerologia (National Cancer Institute) in Bogota, Colombia.The clinical histories of 692 adult patients hospitalized in the Instituto Nacional de Cancerologia between 1997 and 2001 with a diagnosis of leukemia or lymphoma were reviewed. Thirty-five of these cases met the criteria for probable or confirmed neutropenic enterocolitis.Twenty-two cases were confirmed and the remaining 13 were probable neutropenic enterocolitis. All patients were undergoing chemotherapy and all presented watery diarrhea and abdominal pain. In addition, 17% had melena and 25% severe vomiting. Eight of 26 stool cultures (30%) and 17 of 32 (58%) blood cultures were positive for potentially pathogenic microorganisms, particularly gram-negative bacilli. Three patients with probable neutropenic enterocolitis and ten confirmed cases died (37%); mortality was higher among patients who were managed surgically.Neutropenic colitis presents as a multifactorial syndrome in patients with blood cancer undergoing cytotoxic therapy with agents such as cytosine arabinoside, etoposide, vincristine, cyclophosphamide and corticoids. This highly lethal complication is partly due to infections caused by gram-negative bacilli.

The purpose of this study was to investigate the initial clinical features and subsequent outcomes in patients with adult leukemia with typhlitis or neutropenic enterocolitis. A retrospective review of 10 episodes of neutropenic enterocolitis in nine patients (age range, 21-71 years) with acute leukemia from March 1, 1990, through February 28, 2002, was conducted. In clinical presentations, fever appears in all patients, followed by abdominal pain or tenderness (90%) and diarrhea (60%), respectively. In particular, three cases were coincidentally diagnosed as leukemia before any chemotherapy. The most common diagnostic modality used for the diagnosis of neutropenic enterocolitis was computed tomography (CT) scan (seven episodes). Medical treatments, including broad-spectrum antibiotics, bowel rest, and total parenteral nutrition, were applied to seven patients. Laparotomy with bowel resection was performed on two patients with bowel necrosis and severe peritonitis. Of all nine cases, six were fatal as a result of sepsis, a common complication of neutropenic enterocolitis. As the incidence of neutropenic enterocolitis increases in patients with acute leukemia, EPs should be alert and make an early diagnosis of this rapidly deteriorated and life-threatening disease.