Enterocolitis neutropénica en el paciente con neoplasia hematológica

Background: The neutropenic enterocolitis is a syndrome that is developed mainly in patients with hematologic neoplasms subjected to treatment with high dose of chemotherapy; it is characterized by neutropenia, abdominal pain and fever, with bowel wall thickening measured by ultrasonography or computed tomography. There are not reports of incidence neither mortality in Mexico. Objective: To determine the incidence of neutropenic enterocolitis in patient with hematologic neoplasms. Patients and method: Prospective, observational, and analitic study. Male and female patients were included, with diagnosis of hematologic neoplasm demonstrated by histopathology, subjected to treatment with chemotherapy agents, and that secondarily developed neutropenia. Neutropenic enterocolitis was defined with the neutropenia presence, fever, abdominal pain and, preferently, with demonstration for ultrasonography of a bowel wall thickening (BWT) bigger than 4 mm. Results: One-hundred ten patients were included, 58 male (52.7%). It was diagnosed neutropenic enterocolitis in 8 patients with an incidence of 7.27%, 6 of them were male. The mortality of patients with neutropenic enterocolitis was of 62.5% (5). The mean of beginning of neutropenic enterocolitis symptoms later to have begun the chemotherapy administration was of 14.38 days. The 8 patients with neutropenic enterocolitis had neutropenia, fever, abdominal pain with data of peritoneal irritation and diarrheic syndrome; in 6 of them it could be carried out abdominal ultrasonography pointing out BWT bigger than 4 mm. The hematologic neoplasm associated to the presence of NE was the mieloblastic acute leukemia M4 (MAL M4) OR = 9.6, IC 95% (1.84-50), p = 0.018. The cause of death of the patients with neutropenic enterocolitis was septic shock. An association between neutropenic enterocolitis and mortality was found in patients with neutropenia, OR 26.6, IC 95% (5.1-139.1), p < 0.0001. Conclusions: Neutropenic enterocolitis is a little frequent complication, but with high mortality. In this study we found that the MAL-M4 was associated with neutropenic enterocolitis; nevertheless, it is necessary to make new prospective studies to confirm this data.