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- Necrotizing enterocolitis with predilection for cecum.
- Occurs in the immunosuppressed, especially when neutropenic (<500 PMNs)
- Typically a polymicrobial infection; gram positive cocci, gram negative rods, anaerobes, and/or fungal.
- Classically, right lower quadrant pain but can present with diffuse abdominal pain and peritoneal signs.
- CT scan with IV and PO contrast is diagnostic (see below)
- Treatment:
- Culture and begin broad spectrum antibiotics (cover anaerobes) and antifungals (if suspected)
- Aggressive resuscitation
- Surgical consult for GI perforation or clinical deterioration
- High mortality (40-50%)
TIP: Suspect when abdominal pain presents 10-14 after chemotherapy (when PMNs are lowest).
References
Blijlevens NM, et al. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 2000 Jun;25(12):1269-78
http://emedicine.medscape.com/article/375779-overview