Section: Colorectal Sub-section: Acute colorectal
Definition
- Life-threatening, necrotizing enterocolitis occurring primarily in neutropenic patients
- Inflammation and thickening of any part of intestine, most commonly caecum and TI.
- Typically seen in patients on chemotherapy for neoplastic disease or transplant recipients or aplastic anaemia.
Aetiology
- Pathophysiology unclear.
- Mucosal injury by cytotoxic drugs or other means, profound ոеսtrοpeniа, and impaired host defense to invasion by microorganisms
- The microbial infection leads to necrosis of various layers of the bowel wall.
- The cecum is usually affected, and the process often extends into the ascending colon and terminal ileum
Clinical
- Abdominal pain
- Diarrhoea +/- haematochezia
- Nausea/vomiting
- Pyrexia
- Neutropenia common finding, often resolves as patient improves.
Investigations
- Imaging – CT
Management
- Mostly non-operative with IVF, bowel rest and broad spectrum IV abx
- Granulocyte colony-stimulating factor (G-CSF)
- Emergency surgery for perforation & peritonitis
- Urgent surgery for lack of improvement with supportive measures.