Neutropenic Enterocolitis: A Case Report

Neutropenic enterocolitis is an acute syndrome characterized by cecal and ascending colon inflammation that may progress to necrosis and perforation. It is most often associated with leukemia but has also been described in patients with solid tumors, multiple myeloma, aplastic anemia, AIDS, and cyclic neutropenia. Twenty-five year old male patient was admitted with a diagnosis of acute myeloid leukemia. Severe fever, abdominal sensitivity and severe pain and diarrhea with blood developed in the patient treated idarubicin and cytosine arabinoside. Direct abdominal radiogram revealed air-fluid levels, the patient was diagnosed as typhlitis and taken to an emergency operation in which the necrotised small bowel was resected. Severe abdominal pain and sensitivity, diarrhea with blood and thrombocytopenia developed again on the 19th day on which the patient was reoperated. Ileal resection and colostomia was performed on this second operation. Thrombocytopenia, prolonged bleeding and coagulation times and gastrointestinal bleeding was observed. Despite all treatment efforts, the patient developed tachycardia, tachipnea, cognitive changes and sepsis and died. Turkish Baslik: Notropenik Enterokolit: Olgu Sunumu Anahtar Kelimeler: Notropeni; enterokolit Notropenik enterokolit, cikan kolon ve cekumun nekroz ve perforasyonu ile karakterize akut bir tablodur. Siklikla losemi ile iliskili olmakla birlikte solid tumorlu hastalarda, multipl miyelomda, aplastik anemi, AIDS ve siklik notropenide de gorulur. Yirmi bes yasina erkek hasta akut miyelositer losemi tanisi ile yatirildi. Idarubisin ve sitozin arabinozid tedavisi baslanan hastada yuksek ates, karinda hassasiyet ve siddetli agri, kanli ishal gelisti. Direkt batin grafisinde hava sivi seviyeleri saptanan ve acil olarak ameliyat edilen hastaya tiflitis tanisi kondu, nekroze ince bagirsak bolumu rezeke edildi. On dokuzuncu gunde yeniden siddetli abdominal agri, hassasiyet, kanli ishal ve trombositopeni gelisen hasta yeniden ameliyata alindi. Ikinci kez ameliyata alinan hastaya ileyal rezeksiyon yapilarak kolostomi acildi. Ameliyat sonrasi gunlerde trombositopeni, kanama pihtilasma zamaninda bozulma ve gastrointestinal sistem kanamasi gorulen hasta, tum tedavilere karsin tasikardi, takipne, bilinc degisikligi ve sepsis klinigi ile kaybedildi.