INDICATIONS FOR SURGICAL INTERVENTION FOR GASTROINTESTINAL EMERGENCIES IN CHILDREN RECEIVING CHEMOTHERAPY

Background, Abdominal pain in children receiving chemotherapy for canc er presents the clinician with unique problems due to the altered immu nity of these patients or to the oncologic setting. The major clinical decisions regarding these patients are to determine if and when opera tive intervention is indicated. Methods. A retrospective study was don e to examine the clinical, radiographic, and laboratory findings that indicate the need for surgical intervention. Sixty-eight of 1090 child ren who underwent treatment for cancer from October 1982 to December 1 990 developed abdominal complaints requiring them to be hospitalized. Nineteen of these patients underwent exploratory laparotomy (operative ), and the other 49 were observed (nonoperative). Results. No signific ant differences were observed in the phase of chemotherapy, treatment with vincristine or corticosteroids, or the hematologic indices betwee n the operative and nonoperative groups. Eighteen of nineteen patients survived their surgeries. Seventeen (89%) of these laparotomies were positive based on the surgical pathology and the operative report. Per itoneal signs on physical examination (P < 0.001) dr pneumatosis intes tinalis on abdominal radiographs correlated with positive laparotomies (P = 0.001). Conclusions. Peritoneal signs on physical examination or pneumatosis intestinalis on abdominal X-rays were associated with and specific for the presence of