#24: Neutropenic Enterocolitis in the Pediatric Patient with Hematological Cancer at Centro Medico Nacional 20 de Noviembre, from June 2019 to May 2020

Abstract

Abstract Background Neutropenic Enterocolitis is a life-threatening condition which occurs in patients presenting neutropenia (absolute neutrophil count <500 / mm3), where secondary to the use of chemotherapy there is an aggressive destruction of tumor cells, which alters the rapid replication phase, in which different types of epithelia are also involved, this is why they decrease their turnover rate, evolving into injury in the intestinal mucosa, especially at the level of the terminal ileus and cecum, although it can affect any part of the intestine. Clinically manifested by fever, pain, and abdominal distension; it is more frequently associated with hematological cancer, although it can occur in other types of cancer. CT is the Gold Standard for diagnosis. Ultrasonography may also be useful, however, this diagnostic tool is operator dependent so its sensitivity and specificity decrease. Medical treatment is usually sufficient, but surgical intervention may be necessary in patients with perforation or deterioration. Methods The incidence of Neutropenic Enterocolitis cases in the pediatric population was identified by means of a descriptive, cross-sectional and retrospective study. We used clinical records of patients admitted with a diagnosis of leukemia. Data analysis was carried out by means of a non-probability sampling for convenience, creating the database in electronic system followed by the data analysis obtained by the JASP software version 0.13.1.0. Results we took into account a total of 1019 patients with leukemia, from which 95.58 % (n=974) were ALL (Acute Lymphoblastic Leukemia) and 4.41 % (n=45) AML (Acute Myeloblastic Leukemia); the Neutropenic Enterocolitis diagnostic, gave us 49 files, from which we eliminated 12 with a different diagnosis, obtaining a total sample of 37 clinical records. The most affected population was the group of between 10–17 years with an incidence of 51.35 %, the most common type of hematologic cancer was ALL representing 86.4 % of the cases, from which 40.54 % were in the induction phase of treatment when they started with the clinical symptoms of neutropenic enterocolitis, being fever, abdominal pain and diarrhea the most common symptoms. The diagnosis was made based on clinical presentation, and radiology tests being abdominal ultrasound the most common diagnostic tool. The most efficacious treatment because there were no complications and there was no need for escalation, was Piperacillin/Tazobactam, followed by Meropenem. Conclusions Neutropenic Enterocolitis was more frequently diagnosed in patients with ALL and in those who were receiving the induction phase of treatment; a total of 28 % presented with sepsis or septic shock. The antibiotic scheme Piperacillin/Tazobactam suffered less modifications unlike Cefepime/Metronidazole which had to be scaled to carbapenem and just 10.81 % of the patients had the Gold Standard diagnostic tool (Abdominal Computed Tomography).