Ultrasound findings guided a successful hemicolectomy in a leukemic patient with neutropenic enterocolitis.
Ultrasound findings guided a successful hemicolectomy in a leukemic patient with neutropenic enterocolitis.
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DOI：
10.1016/j.jus.2008.05.001
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发表时间：
2008-09-01
影响因子：
2
通讯作者：
Petrini, M
中科院分区：
文献类型：
--
作者：
Benedetti, E;Lippolis, P V;Petrini, M
引言：中性粒细胞减少性小肠结肠炎（NEC）可能是白血病患者化疗的一种危及生命的并发症。因此，早期诊断和治疗是至关重要的。方法：一个38岁的女性急性淋巴细胞白血病和化疗引起的中性粒细胞减少症突然出现症状怀疑NEC。经腹部超声显示符合NEC的特征，随后通过计算机断层扫描（CT）证实。结果：患者使用便携式超声（US）设备（Esaote My Lab 25）进行扫描。超声检查结果显示盲肠、阑尾、升结肠和近端中横结肠受累，结肠壁本身具有类似含气裂隙的特征。CT扫描证实结肠破裂的风险。患者进行了成功的半结肠切除术后静脉治疗广谱抗生素，粒细胞集落刺激因子（G-CSF），血小板和新鲜冷冻血浆transfusion.Discussion：一个迅速的床旁US检查后，症状的发展允许NEC的早期诊断和确定的功能符合即将发生的结肠壁破裂，转移到手术治疗这种危及生命的并发症。多学科的干预是成功的半结肠切除术，在严重影响贫血患者的关键。
INTRODUCTION: Neutropenic enterocolitis (NEC) can be a life-threatening complication of chemotherapy in leukemic patients. Early diagnosis and treatment is therefore crucial.METHODS: A 38-year-old woman with acute lymphoblastic leukemia and chemotherapy-induced neutropenia suddenly developed symptoms suspicious of NEC. Transabdominal ultrasound showed features consistent with NEC, later confirmed by computed tomography (CT) scan.RESULTS: The patient was scanned using portable ultrasound (US) equipment (Esaote My Lab 25). US findings showed involvement of the cecum, appendix, ascending colon and proximal middle transverse colon, with features resembling gas containing fissures within the colon wall itself. The risk of colon rupture was confirmed by CT scan. The patient underwent successful hemicolectomy after intravenous treatment with broad spectrum antibiotics, granulocyte-colony stimulating factor (G-CSF), platelets and fresh frozen plasma transfusion.DISCUSSION: A prompt bedside US examination upon development of symptoms allowed an early diagnosis of NEC and identified features consistent with imminent colon wall rupture, shifting the management of this life-threatening complication from medical to surgical. Multidisciplinary intervention was crucial for a successful hemicolectomy in a severely affected neutropenic patient.