Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

Catena, Fausto; Improta, Mario; Sartelli, Massimo; Raşa, Kemal; Sawyer, Robert G.; Coimbra, Raúl; Chiarugi, Massimo; Litvin, Andrey; Hardcastle, Timothy Craig; Forfori, Francesco; Vincent, Jean‐Louis; Hecker, Andreas; Broek, Richard ten; Bonavina, Luigi; Chirica, Mircea; Boggi, Ugo; Pikoulis, Emmanuel; Saverio, Salomone Di; Montravers, Philippe; Augustin, Goran; Tartaglia, Dario; Cicuttin, Enrico; Cremonini, Camilla; Viaggi, Bruno; Simone, Belinda De; Malbrain, Manu L. N. G.; Shelat, Vishal G; Fugazzola, Paola; Ansaloni, Luca; Işık, Arda; Rubio, I Miró; Kamal, Itani; Corradi, Francesco; Tarasconi, Antonio; Gitto, Stefano; Podda, Mauro; Pikoulis, Anastasia; Leppäniemi, Ari; Ceresoli, Marco; Romeo, Oreste; Moore, Ernest E.; Demetrashvili, Zaza; Biffl, Walter L.; Wani, Imitiaz; Tolonen, Matti; Duane, Therèse M.; Dhingra, Swati; de’Angelis, Nicola; Tan, Edward; Abu‐Zidan, Fikri M.; Ordóñez, Carlos A.; Y, Cui; Labricciosa, Francesco M.; Perrone, Gennaro; Marzo, Francesco Di; Peitzman, Andrew B.; Sakakushev, Boris; Sugrue, Michael; Boermeester, Marja A.; Manzano-Núñez, Ramiro; Gomes, Carlos Augusto; Bala, Miklosh; Kluger, Yoram; Catena, Fausto

doi:10.1186/s13017-021-00380-1

Cited by 32 publications

(45 citation statements)

References 170 publications

(191 reference statements)

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“…In our series, wherein all cases showed radiological signs of NE, the mortality related to the condition occurred in 16% of all patients (27 of 171). This gure was much better than those reported by others, wherein mortality in patients with US or CT scan positive for suggestive signs of neutropenic enteritis or typhlitis reached 29.5% [24]. The mortality rate in the conservative arm was 10% (24 of 138), and among those who failed conservative management and were then referred to surgery, the mortality was 39% (13 of 33).…”

Section: Resultsmentioning

confidence: 58%

Challenges in surgical management of neutropenic enterocolitis in pediatric cancer patients

Ahmed

Refaat

Eltagy

et al. 2023

Preprint

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Neutropenic enterocolitis (NE) affects immunocompromised patients with incidence ranging from 2.6% to 11.6%. The pathogenesis of NE is poorly understood. The recommended treatment is highly controversial, with some suggesting supportive care and others advocating surgery. The present study intended to characterize the outcome, prognostic factors and indications of surgery among those patients PATIENTS AND METHODS This is a retropective cohort observational study conducted during January 2019–2022 on patients aged <18 years with NE. Conservative management was initially started and surgical interventions were done after the failure of conservation. RESULTS Among 5736 patients diagnosed with malignant diseases, 171 patients (3%) developed NE, of them 33 required surgical intervention. Patients with bowel wall thickness <10 mm, isolated drug-resistant organisms, and multifocal distribution were associated with failure of conservative management. deterioration on maximum supportive measures (70%, n = 23), was the most common indication for surgery. The overall 30-day mortality was 18%. The mortality rate in the surgery and conservative arms were 39% and 10% respectively (p = <0.001). Factors associated with higher mortality in all groups were: Drug-resistant blood cultures and multifocal distribution. Vasopressors showed higher mortality in the surgery group (p = 0.003). The bowel wall thickness of >10 mm was associated with higher mortality in the whole (p = 0.001) and conservative groups (p = 0.001). CONCLUSIONS Most patients with NE respond to conservative management. Deterioration in maximum supportive care is the most common indication for surgery. positive blood culture, multifocal distribution, vasopressors and bowel wall thickness of >10 mm were associated with higher mortality.

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Section: Resultsmentioning

confidence: 58%

Challenges in surgical management of neutropenic enterocolitis in pediatric cancer patients

Ahmed

Refaat

Eltagy

et al. 2023

Preprint

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“…A few studies have indicated that nonoperative management of uncomplicated diverticulitis in the immunocompromised may be safe and effective, even for recurrences [26,27]. Even though, similar failure rates of nonoperative treatment in acute sigmoid diverticular disease with equally severe disease distribution have been shown in patients with chemotherapy by Samdani et al [19], nonoperative treatment in IMS in the first episode of diverticulitis with abscess formation remains unclear and should be individualised [7,8,18,[28][29][30].…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group

Ocaña,

García‐Pérez,

Fernández‐Martínez

et al. 2023

Colorectal Disease

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AimManagement of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short‐ and long‐term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery.MethodsA nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015–2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS.ResultsA total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57–7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01–4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26–2.83), use of morphine, p < 0.001; OR: 3.08 (1.98–4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33–2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001–1.002) were independently associated with emergency surgery in IMS.ConclusionNonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.

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“…Patients with immunocompromise, including those with HIV infection, solid organ transplant, and malignancy, may have a reduced inflammatory response, which can lead to atypical and delayed presentations 6. These patients have a higher risk of poor outcomes related to intra-abdominal infection 7.…”

Section: Discussionmentioning

confidence: 99%

Complicated appendicitis in a patient with myelodysplastic syndrome and pancytopenia

Gaffney¹,

Dunson²

2022

Jaapa

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Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

Cited by 32 publications

References 170 publications

Challenges in surgical management of neutropenic enterocolitis in pediatric cancer patients

Challenges in surgical management of neutropenic enterocolitis in pediatric cancer patients

Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group

Complicated appendicitis in a patient with myelodysplastic syndrome and pancytopenia

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