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Neutropenic enterocolitis: is it possible to break vicious circle between neutropenia and the bowel wall inflammation by surgery?

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Abstract

Background

Neutropenic enterocolitis is a devastating bowel wall inflammation in patients with protracted neutropenia. The approach for diagnosis and treatment is still controversial, and it is difficult and challenging to decide on what should be the next step in the management.

Case presentation

We report a 10-year-old boy who developed neutropenic enterocolitis in the course of the conservative treatment for aplastic anemia. Oral mucositis and the perianal fissure with an ulcer were important indicators for what was happening on the colonic mucosa. Colonoscopy and biopsy confirmed the diagnosis. A fast recovery was achieved with a right hemicolectomy and ileostomy.

Conclusion

Retrospective analysis of the long-term follow-up of our patient suggests that defunctioning the colon by ileostomy breaks the vicious circle between neutropenia and bowel wall inflammation, and an early surgical intervention could be considered as an adjunctive approach to the conservative management of persistent cases.

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References

  1. Larsen TK, Qvist N, Bak M (2001) Delayed neutropenic enterocolitis in a 12-year-old girl treated with total colectomy and J-pouch reservoir. J Pediatr Surg 36:1066–1067

    Article  CAS  PubMed  Google Scholar 

  2. Baerg J, Murphy JJ, Anderson R, Magee JF (1999) Neutropenic enteropathy: a 10-year review. J Pediatr Surg 34:1068–1071

    CAS  PubMed  Google Scholar 

  3. Davila AD, Willenbucher RF (1998) Other diseases of the colon and rectum. In: Feldman M, Sleisenger MH, Scharschmidt BF (eds) Sleisenger and Fordtran's gastrointestinal and liver disease. Saunders, Philadelphia, pp 1977–2006

  4. Katz JA, Wagner ML, Gresik MV, Mahoney DH, Fernbach DJ (1990) Typhlitis. An 18-year experience and postmortem review. Cancer 65:1041–1047

    CAS  PubMed  Google Scholar 

  5. Moir DH, Bale P (1976) Necropsy findings on childhood leukaemia emphasizing neutropenic enterocolitis and cerebral calcification. Pathology 8:247–258

    CAS  PubMed  Google Scholar 

  6. Amromin GD, Solomon RD (1962) Necrotizing enteropathy: a complication of treated leukemia or lymphoma patients. JAMA 182:23–29

    CAS  Google Scholar 

  7. Varki AP, Armitage JO, Feagler JR (1979) Typhlitis in acute leukemia. Successful treatment by early surgical intervention. Cancer 43:695–697

    Google Scholar 

  8. Koea JB, Shaw JH (1989) Surgical management of neutropenic enterocolitis. Br J Surg 76:821–824

    CAS  PubMed  Google Scholar 

  9. Kulaylat M, Doerr R, Ambrus J (1997) A case presentation and review of neutropenic enterocolitis. J Med 28:1–19

    Google Scholar 

  10. Jain Y, Arya LS, Kataria R (2000) Neutropenic enterocolitis in children with acute lymphoblastic leukemia. Pediatr Hematol Oncol 17:99–103

    Article  CAS  PubMed  Google Scholar 

  11. Shamberger RC, Weinstein HI, Delorey MJ, Levey RH (1986) The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer 57:603–609

    CAS  PubMed  Google Scholar 

  12. Gorschluter M, Glasmacher A, Hahn C, Leutner C, Marklein G, Remig J, Schmidt-Wolf IG, Sauerbruch T (2001) Severe abdominal infections in neutropenic patients. Cancer Invest 19:669–677

    Article  CAS  PubMed  Google Scholar 

  13. Scott-Conner CE, Fabrega AJ (1996) Gastrointestinal problems in the immunocompromised host. A review for surgeons. Surg Endosc 10:959–964

    Article  CAS  PubMed  Google Scholar 

  14. Wade DS, Nava HR, Douglas HO (1992) Neutropenic enterocolitis, clinical diagnosis and treatment. Cancer 69:17–23

    CAS  PubMed  Google Scholar 

  15. Gomez L, Martino R, Rolston KV (1998) Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infect Dis 27:695–699

    CAS  PubMed  Google Scholar 

  16. Shaked A, Shinar E, Freund H (1983) Neutropenic typhlitis: a plea for conservatism. Dis Colon Rectum 26:351–352

    CAS  PubMed  Google Scholar 

  17. Alt B, Glass NR, Sollinger H (1985) Neutropenic enterocolitis in adults. Review of the literature and assessment of surgical intervention. Am J Surg 149:405–408

    CAS  PubMed  Google Scholar 

  18. Moir CR, Scudamore CH, Benny WB (1986) Typhlitis: selective surgical management. Am J Surg 151:563–566

    CAS  PubMed  Google Scholar 

  19. Ikard RW (1981) Neutropenic typhlitis in adults. Arch Surg 116:943–945

    CAS  PubMed  Google Scholar 

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Correspondence to Baran Tokar.

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Tokar, B., Aydoğdu, S., Paşaoğlu, Ö. et al. Neutropenic enterocolitis: is it possible to break vicious circle between neutropenia and the bowel wall inflammation by surgery?. Int J Colorectal Dis 18, 455–458 (2003). https://doi.org/10.1007/s00384-003-0502-3

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  • DOI: https://doi.org/10.1007/s00384-003-0502-3

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