Neutropenic Enterocolitis in Children With Acute Lymphoblastic Leukemia

Abstract

Neutropenic enterocolitis is an acute, life-threatening inflammation of the small and large bowel, often seen in children with malignancies during periods of prolonged or severe neutropenia. During the period 1990-1995, 180 children were treated at the authors' center for acute lymphoblastic leukemia using a standard chemotherapy protocol. Among them, 11 children (6.1%) aged 4 to 12 years, were diagnosed clinically to have neutropenic enterocolitis. Eight had severe neutropenia (absolute neutrophil count < 10(8)/L and 5 had prolonged neutropenia (> 7 days duration). The symptoms included diffuse abdominal pain (10 children), oral mucositis (7), hematochezia (7), diarrhea (6), hematemesis (5), and right lower quadrant tenderness (4). Three children had radiological evidence of free intraperitoneal gas and an additional 3 children were found on surgical exploration to have cecal perforation. Laparotomy was performed on 8 children (73%), 4 of whom survived. Among the 3 children managed conservatively, 1 died awaiting surgical exploration, while the other 2 did well. The overall survival was 55%. The authors recommend an approach to management that respects the heterogeneity of the disease.

Diarrhea in neutropenic children with cancer: An Egyptian center experience, with emphasis on neutropenic enterocolitis

“…[2425] These results, although variable in different patient populations, underscore the importance of NE as a clinical problem. [7]…”

“…[21] Older patients not only are at a greater risk of typhlitis but may also not respond as well as compared to younger patients to its management. [25]…”

Neutropenic enterocolitis

“…Patients with transmural necrosis tend to have a more difficult postoperative course and are more likely to have cecal perforations [23].…”

Neutropenic enterocolitis as a presenting complication of acute lymphoblastic leukemia: an unusual case marked by delayed perforation of the descending colon

“…1 NE occurs most often in patients receiving intensive chemotherapy for acute leukemia, but it has been observed in patients who are neutropenic from other causes. [1][2][3][4] We report the case of a child who had NE affecting the descending colon as a presenting complication of acute lymphoblastic leukemia (ALL). Despite aggressive medical management, including granulocyte infusions, she had a delayed bowel perforation necessitating surgical intervention.…”