Neutropenic enterocolitis in children and young adults with cancer: prognostic value of clinical and image findings.

Intensive chemotherapy regimens can result in severe toxicities, particularly those that involve the digestive systems, leading to morbidity and mortality in this group of patients. Acute enterocolitis can be a frequent complication. The authors performed a retrospective review or patients treated at their institution to ascertain the prognostic value of the clinical symptoms and signs of acute enterocolitis, the corresponding abdominal ultrasonographic findings, and the impact of previous chemotherapy. Amongst 1159 patients with cancer treated at the Centro Infantil Boldrini from 2003 to 2007, 188 (16.2%) patients had 1 or more episode of enterocolitis. An intestinal wall thickness of >or=3 mm on ultrasound was considered diagnostic of enterocolitis. There were 231 episodes of enterocolitis with a death rate of 11.7%. Previous therapy with cytarabine and the presence of abdominal distention affected survival. An intestinal wall thickness of >or=10 mm in the ultrasonographic examination was associated with greater mortality. In multivariate analysis, age, gender, tumor type, degree of neutropenia, intestinal wall thickness, and number of intestinal segments were not statistically significant difference. In children and young adults with cancer and enterocolitis, the clinical findings of 4 or more symptoms and presence of abdominal distention were associated with higher risk of death. Use of cytarabine and an intestinal wall thickness of >or=10 mm were associated with a higher death rate.

Enterocolites em crianças e dolescentes com câncer: valor prognóstico dos achados clínicos e de imagem / Enterocolitis in children and adolescents with cancer: prognostic value of clinical and image findings

Introdução: O aumento da sobrevida dos pacientes pediátricos portadores de câncer se deve aos avanços no diagnóstico, nas técnicas cirúrgicas e radioterápicas, na terapia de suporte e, entre outros fatores, aos regimes quimioterápicos intensivos. Estes procedimentos tornam tais pacientes mais vulneráveis às intercorrências infecciosas, principalmente decorrentes de graus variáveis de mielotoxicidade. Dentre as infecções com elevada morbimortalidade se destaca a enterocolite. Além das complicações inerentes a esta patologia, interrupções e alterações do esquema quimioterápico, diferentes graus de desnutrição e óbito não raramente ocorrem. Poucas são as publicações na literatura sobre esta entidade na pediatria oncológica, principalmente com foco na complexidade da definição dos critérios diagnósticos da enterocolite e os diagnósticos diferenciais com outras patologias abdominais, que podem ocorrer ao longo da terapia do câncer. Objetivos: 1. Estudar o valor prognóstico dos sintomas e sinais clínicos em pacientes pediátricos com o diagnóstico de enterocolite, na vigência de tratamento oncológico. 2. Estudar o valor prognóstico dos achados ultrassonográficos abdominais com o quadro clínico e evolução destes pacientes. Material e Métodos: Estudo retrospectivo realizado em 188 pacientes portadores de câncer abaixo de 25 anos de idade, consecutivamente diagnosticados e tratados no Centro Infantil Boldrini,acompanhados no período de 2003 a 2007, com o diagnóstico clínico presuntivo de colite. O diagnóstico confirmatório de enterocolite foi baseado na espessura da parede intestinal igual ou superior a 3 milímetros, verificada ao exame ultrassonográfico abdominal, dos pacientes com a queixa de um ou mais sintomas relacionados (dor ou tensão abdominal, vômitos, diarréia, associados ou não a febre)...

Introduction: Increased survival rates for patients with oncological diseases are among other factors, due to intensive chemotherapy regimens, which turn such patients vulnerable to infectious complications secondary to severe myelotoxicity. Among these, it is worth to mention the necrotizing enterocolitis (or typhlitis), exposing the patient to therapy interruptions, chemotherapy regimen changes, delayed treatment, weight loss and eventually death. Few published studies and nonconsensus criteria for diagnostic confirmation of colitis, among other abdominal diseases along cancer therapy in children and adolescents, justify this study. Objectives: 1. To study the prognostic value of clinical signs and symptoms in pediatric patients with enterocolitis diagnosis. 2. To study the prognostic value of abdominal ultrasound findings, related to clinical features and survival of these patients...