CHANGING PRESENTATION AND MANAGEMENT OF NEUTROPENIC ENTEROCOLITIS

Objective: To characterize the current clinical presentation and manag ement of neutropenic enterocolitis. Design: Retrospective review of re cords of oncology unit patients requiring general surgical consultatio n for abdominal complaints in a 1-year period. Setting: Oncology unit of a tertiary care, university teaching hospital. Patients and Interve ntions: Fourteen patients diagnosed as having neutropenic enterocoliti s were managed conservatively with operation reserved for failure of c onservative therapy. Main Outcome Measures: Clinical data from patient s at the time of presentation and during treatment for neutropenic ent erocolitis. Results: All 14 patients diagnosed as having neutropenic e nterocolitis were receiving chemotherapy for solid tumors or leukemias . Seven patients were undergoing stem cell or autologous bone marrow t ransplantation. Presenting symptoms and physical examination findings were nonspecific. All patients except one had neutropenia at the time of diagnosis. Computed tomographic scans of the abdomen were the most useful confirmatory study for the diagnosis of neutropenic enterocolit is. All patients except one had resolution of neutropenic enterocoliti s with conservative therapy. One patient whose course of conservative management failed had protracted neutropenia and required operation fo r resection of bowel with full-thickness necrosis. Conclusions: Neutro penic enterocolitis has evolved from a complication of patients with l eukemia to a disease of patients receiving high-dose chemotherapy for many malignancies, solid as well as hematologic. Diagnosis of neutrope nic enterocolitis continues to be a challenge, as patients typically p resent with nonspecific gastrointestinal tract symptoms. Neutropenia a nd computed tomographic scan findings are useful adjuncts in diagnosin g neutropenic enterocolitis. Timely conservative treatment frequently allows resolution of neutropenic enterocolitis without operation.