A Sofia Espinoza (1st year surgical resident)
Borja De Lacy (3rd year surgical resident)
Mario Pagès (Radiology Consultant)
Hospital Clínic, Barcelona – Spain
A 59-year-old female a with past medical history of diffuse Lage B-Cell Lymphoma treated with R-CHOP chemotherapy and local radiotherapy 10 years ago consulted her doctor due to a big abdominal mass. After initial testing a PET-Scan was performed, revealing multiple and retroperitoneal lymph nodes. A recurrent disease was diagnosed and R-ESAHP chemotherapy was started. Eight days after the third cycle, the patient complained of acute abdominal pain and came to the emergency room.
She was diagnosed with a septic shock, requiring vasoactive drugs and intensive IV fluids administration. Her blood test revealed pancytopenia (Hemoglobin 6,4 g/L – WBC 0,51 109/L – 0,77 109/L neutrophils – 9000 109/L platelets). A CT-Scan was performed revealing a thickening of the terminal ileum, the right colon, and specially the transverse colon with fat tissue trabeculation. There was no pneumoperitoneum or colonic pneumatosis (FIG. 1). All vessels were permeable.
A neutropenic enterocolitis was diagnosed due to the patient’s record and the CT findings.
There was no perforation, peritonitis or bleeding. She was admitted to the intensive care unit receiving amikacin, teicoplanin and tigecycline. Close medical surveillance was provided. Blood and stools cultures came back negative. RCP for cytomegalovirus was negative.
Ciprofloxacin plus metronidazole were administered orally until antibiotics until a 14-day antibiotics course had been completed.
The patient had a good clinical and hematologic response, so there was no need to provide surgical treatment.