Martínez Martínez L, Sastre Urgellés A, Ortega Martínez de Victoria L, Fernández Sánchez A, López Gutierrez J C, Vallejo Díaz D, Perdiguero Martínez M, Velasco Sánchez B, Díez Pascual R, Lobato Romera R, Tovar Larrucea J A
Departamento de Cirugía Pediátrica, Hospital Infantil La Paz, Madrid.
An Esp Pediatr. 1997 Apr;46(4):367-71.
Neuropenic enterocolitis (NEC) is a destructive lesion of the ileocecal region occurring in cancer patients treated with chemotherapy. Its clinical picture is one of febrile acute abdominal extension with bloody diarrhea and low neutrophil counts. Our aim was to determine the incidence of NEC in children with cancer and to review the indications of surgery in these cases.
The records of children with cancer treated with chemotherapy in the last 6 years at Hospital Infantile La Paz were reviewed. We selected those patients who had abdominal pain and neutropenia and whose physical examination and radiological findings were consistent with NEC.
Twelve cases of NEC were diagnosed during this period among 432 malignancies. The symptoms most frequently seen were abdominal pain and distension, nausea and vomiting. The neutrophil count was consistently below 500/ml. All patients were receiving chemotherapy before the onset of the clinical picture. Five children were operated upon. In three of these we found various ileocecal perforations, in one a gastric perforation and in the remaining one a diffuse inflammation of the ileocecal area. Two non-operated patients died from NEC. The remaining children recovered without problems with medical therapy.
Pediatric surgeons treating neutropenic cancer patients should be familiar with this condition, that must be suspected early in granulocytopenic patients with acute abdominal extension. Aggressive surgical management is indicated in cases with severe peritonitis, bowel perforation or massive lower gastrointestinal bleeding, irrespective of the degree of neutropenia. Medical support should aim at reestablishing normal neutrophil counts.
神经源性小肠结肠炎（NEC）是接受化疗的癌症患者回盲部发生的一种破坏性病变。其临床表现为发热伴急性腹部症状加重、血性腹泻及中性粒细胞计数降低。我们的目的是确定癌症患儿中NEC的发病率，并回顾这些病例的手术指征。
回顾了过去6年在拉巴斯儿童医院接受化疗的癌症患儿的病历记录。我们选择了那些有腹痛和中性粒细胞减少症，且体格检查和影像学检查结果与NEC相符的患者。
在此期间，432例恶性肿瘤患者中诊断出12例NEC。最常见的症状是腹痛、腹胀、恶心和呕吐。中性粒细胞计数持续低于500/ml。所有患者在临床表现出现前均接受化疗。5名患儿接受了手术。其中3例发现回盲部多处穿孔，1例胃穿孔，另1例回盲部弥漫性炎症。2例未手术的患者死于NEC。其余患儿经药物治疗后顺利康复。
治疗中性粒细胞减少的癌症患儿的小儿外科医生应熟悉这种疾病，对于急性腹部症状加重的粒细胞减少患者应尽早怀疑。对于伴有严重腹膜炎、肠穿孔或大量下消化道出血的病例，无论中性粒细胞减少程度如何，均应积极进行手术治疗。药物支持应旨在恢复正常的中性粒细胞计数。
