Our Summary

This research paper looks at patients suffering from neutropenic enterocolitis (NEC), a severe intestinal condition that can occur in people with very low levels of a type of white blood cell called neutrophils. This study specifically examines the factors that lead to some of these patients needing an emergency procedure called a colectomy, where part or all of the colon is removed.

The researchers looked back at patient data from November 2009 to May 2018. They found 39 patients with NEC, all of who had a blood disorder. The majority (76.9%) were treated with medicines alone, while 23.1% required a colectomy. They found no difference in the need for surgery based on the patient’s age, sex, or other health conditions.

However, they did find that patients who developed complications like abdominal bloating, issues with blood pressure and circulation (hemodynamic failure), breathing problems (respiratory failure), multiple organ failure, or who needed to be admitted to the intensive care unit were more likely to need a colectomy. Of all these factors, respiratory failure was the most significant predictor of needing surgery.

The study also found that the death rate in hospital was higher in the group that had surgery (44.4%) compared to the group that was treated with medicines alone (13.3%).

In conclusion, the study suggests that most NEC patients are treated with medicines alone, but those who develop serious complications or need intensive care are more likely to require a colectomy. The researchers recommend that all NEC patients should be evaluated for possible surgery early on.

FAQs

  1. What is neutropenic enterocolitis and how is it typically treated?
  2. What factors were identified in the study as increasing a patient’s likelihood of needing a colectomy?
  3. What was the in-hospital mortality rate for patients who underwent colectomy compared to those who were treated with medical management alone?

Doctor’s Tip

A helpful tip a doctor might tell a patient about colectomy is to closely monitor for symptoms such as abdominal distention, hemodynamic failure, respiratory failure, and multi-organ failure. If any of these symptoms develop, it is important to seek medical attention promptly as they may indicate the need for emergent colectomy. Additionally, patients with neutropenic enterocolitis should consider early surgical consultation to discuss potential treatment options.

Suitable For

Patients who are typically recommended for colectomy for the treatment of neutropenic enterocolitis include those who develop abdominal distention, hemodynamic failure, respiratory failure, multi-organ failure, and require ICU admission. These patients may have a higher risk of in-hospital mortality if they undergo surgical treatment compared to medical treatment. Therefore, early surgical consultation is suggested for all patients with neutropenic enterocolitis.

Timeline

  • Before colectomy:
  1. Patient is admitted with neutropenic enterocolitis (NEC), a complication of neutropenia.
  2. All patients have a hematological disorder.
  3. Medical treatment is attempted in 76.9% of patients.
  4. Factors such as abdominal distention, hemodynamic failure, respiratory failure, multi-organic failure, and ICU admission are present in patients who eventually undergo colectomy.
  5. Surgical consultation may be recommended in patients with NEC.
  • After colectomy:
  1. 9 out of 39 patients underwent emergent colectomy for NEC.
  2. In-hospital mortality is higher in the surgical treatment group compared to the medical treatment group.
  3. Respiratory failure is identified as an independent risk factor for colectomy.
  4. Early surgical consultation is suggested for all patients with NEC.

What to Ask Your Doctor

  1. What is the purpose of a colectomy in the treatment of neutropenic enterocolitis?
  2. What are the potential risks and complications associated with colectomy?
  3. How long is the recovery period following a colectomy?
  4. What are the alternative treatment options for neutropenic enterocolitis?
  5. How will my quality of life be affected after undergoing a colectomy?
  6. What is the likelihood of needing a permanent ostomy after a colectomy?
  7. How many colectomies have you performed for neutropenic enterocolitis, and what is your success rate?
  8. How will my nutritional needs be managed after a colectomy?
  9. Will I need additional treatments or follow-up care after the colectomy?
  10. Are there any specific lifestyle changes I should make before or after the colectomy?

Reference

Authors: Vergara-Fernández O, Trejo-Avila M, Solórzano-Vicuña D, Santes O, Salgado-Nesme N. Journal: Langenbecks Arch Surg. 2019 May;404(3):327-334. doi: 10.1007/s00423-019-01781-2. Epub 2019 Apr 5. PMID: 30953135