Surgical and laboratory findings in children with neutropenic enteropathy

• Published in: British journal of surgery Vol. 87; no. 7; p. 955
• Main Authors: Tireli, G. A., Özbey, H., Eryilmaz, E., Salman, T., Anak, S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.07.2000
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.2000.01544-58.x

Background The term neutropenic enteropathy (NE) is used to describe inflammatory conditions of the gastrointestinal system in patients who receive chemotherapy for haematological malignancy. Although the initial treatment of choice in NE is non‐operative, with bowel rest, decompression, nutritional support and broad‐spectrum antibiotics, operative intervention is needed in patients with the advent of the disease. The surgical and laboratory findings of seven patients with NE who required surgical treatment are presented. Methods Patients' medical records were reviewed to obtain age, sex, diagnosis, laboratory findings with neutrophil counts, blood cultures and the surgical findings. The onset of neutropenia and the diagnosis of NE were recorded for each patient. Results There were four girls and three boys, with a mean age of 6 years (range 9 months to 16 years). The primary diseases were acute myelocytic leukaemia in two, acute lymphocytic leukaemia in one and lymphoma in four patients. In all but two patients, the neutrophil counts were less than 1000 mm−3, with positive blood cultures at diagnosis. The onset of the NE was determined as mean(s.d.) 3(2) days after the onset of neutropenia. Haemorrhage, marked oedema, patchy inflammation and multiple adhesions of the bowel, perforation and localized abscess were the main operative findings. The lesions were mostly localized in the terminal ileum and the ascending colon. After resection of the affected segment of bowel, stomas (three) and end‐to‐end anastomoses (three) were performed. Primary repair of the perforation site was performed in one patient with gastric perforation. Four patients recovered with rapid resolution of neutropenia, while three patients with persistent neutropenia died. Conclusion A favourable outcome for patients with NE is related to early recognition of the intra‐abdominal infection, appropriately timed surgical intervention and a prompt postoperative return of normal circulating levels of neutrophils. © 2000 British Journal of Surgery Society Ltd