Neutropenic enterocolitis: A clinico-pathological review

Abstract

Neutropenic enterocolitis (NE) is a predominantly cecum-based disease with high mortality seen in patients post chemotherapy. The pathogenesis of NE is poorly understood and probably multifactorial involving mucosal injury, neutropenia, and impaired host defense to intestinal organisms. The clinical presentation is characterized as ileocolonic inflammation and bowel wall thickening in patients with neutropenia, fever, and abdominal pain. The pathological features of NE include patchy necrosis, hemorrhage, ulcer, edema, perforation, infiltrating organisms, and characteristically, depletion of inflammatory cells (neutrophils). NE should always be considered as a possible diagnosis in immunosuppressed patients, especially those receiving chemotherapy. High clinical and histological diagnostic discordance rate exists. High index of clinical suspicion and prompt appropriate personalized management are essential to achieve a lower mortality rate.

Paclitaxel-Induced Bowel Perforation: A Rare Cause of Acute Abdomen

“…Endoscopy is relatively contraindicated in NEC; yet histological examination remains the gold standard for its diagnosis. Endoscopic characteristics of NEC, obtained via colonoscopy or sigmoidoscopy, include mucosal ulceration, edema, erosions, erythema, pseudomembrane, nodularity, friability, and loss of vascular pattern [13]. Conservative treatment with antibiotics, bland diet, hydration, and an effective pain treatment is favored for the treatment of neutropenic enterocolitis [34], whereas surgical intervention is necessary in cases of fulminant colitis and perforation [35].…”

“…Gastrointestinal toxicities due to chemotherapy include secretory/osmotic diarrhea [2, 8], altered intestinal motility [9], gastrointestinal perforation especially with angiogenesis inhibitors [10], direct mucosal cell toxicity with microtubule inhibitors such as taxanes [11], and decreased host defenses such as with immune check point modulators [12]. Neutropenic enterocolitis, ischemic colitis, and Clostridium difficile colitis have all been reported after high-dose chemotherapy [13].…”

Neutropenic Enterocolitis in the Treatment of Solid Tumors: A Case Report and Review of the Literature

“…The exact incidence of typhlitis is not known. The percentages reported in the literature vary from 2.8 to 5% of patients admitted for acute abdomen during chemotherapy treatments [12,13]. This percentage, however, concerns both hematological and oncological patients.…”

“…The risk of serious complications is high as well as mortality. Furthermore, there is a risk of recurrence in patients treated conservatively [13]. The treatment options are, in fact, both conservative and surgical.…”

“…It has been reported that the presence of neutropenia should not be considered as a contraindication to surgery [39]. The mortality rate is high (32-50%), although it has been improving in recent years thanks to more efficient medical treatments [13].…”