Nishikawa Saki, Hamaoka Michinori, Nakahara Hideki, Itamoto Toshiyuki
Department of Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan.
Department of Pathology, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan.
Surg Case Rep. 2021 Jan 23;7(1):29. doi: 10.1186/s40792-021-01117-7.
Cyclic neutropenia is a disease that causes a neutropenic decrease in peripheral blood in a cycle of about 21 days. It is a rare hereditary disorder with an estimated incidence of 0.5-1 cases per million population. The absolute neutrophil count can drop to zero, and neutropenic nadir may last for 3-5 days. This is a rare disease, and there are few reports of abdominal surgery in cyclic neutropenia patients; thus, we report this case of neutrophil count fluctuation and perioperative management.
A 31-year-old man with cyclic neutropenia was transferred to our hospital complaining of right season rib pain, but no rebound tenderness. His C-reactive protein was elevated (4.37 mg/L) and computed tomography revealed a large number of small stones in the gallbladder body and an incarceration in the gallbladder neck. He was diagnosed with acute cholecystitis. Ideally, surgical intervention should have been performed immediately, but because his neutrophil count was 300/μL, endoscopic naso-gallbladder drainage was performed and he was provided antibiotics until his neutrophil count increased to acceptable levels. Three days after admission, his neutrophil count had increased and laparoscopic cholecystectomy was performed. For one week after the operation, antibiotics were administered; he had an uneventful postoperative recovery. He was discharged on the seventh postoperative day and provided an oral antibiotic.
Infection can be serious in patients with cyclic neutropenia, and it is therefore, important to determine the timing of surgery and to apply appropriate perioperative management with drainage and antibiotic administration.
周期性中性粒细胞减少症是一种以约21天为周期导致外周血中性粒细胞减少的疾病。它是一种罕见的遗传性疾病，估计发病率为每百万人口0.5 - 1例。绝对中性粒细胞计数可降至零，中性粒细胞减少的最低点可能持续3 - 5天。这是一种罕见疾病，关于周期性中性粒细胞减少症患者腹部手术的报道很少；因此，我们报告了这例中性粒细胞计数波动及围手术期管理的病例。
一名31岁的周期性中性粒细胞减少症男性患者因右侧季肋部疼痛转入我院，无反跳痛。他的C反应蛋白升高（4.37mg/L），计算机断层扫描显示胆囊体部有大量小结石且胆囊颈部有嵌顿。他被诊断为急性胆囊炎。理想情况下，应立即进行手术干预，但由于他的中性粒细胞计数为300/μL，遂进行了内镜鼻胆管引流，并给予抗生素治疗，直至其中性粒细胞计数升至可接受水平。入院三天后，他的中性粒细胞计数升高，进行了腹腔镜胆囊切除术。术后一周给予抗生素治疗；他术后恢复顺利。术后第七天出院，并给予口服抗生素。
周期性中性粒细胞减少症患者的感染可能很严重，因此确定手术时机并采用适当的围手术期管理，包括引流和抗生素给药，非常重要。
