A. Cruz, S. C. Lima, S. Barroso, J. Cotter *
Resumo
A enterocolite neutropénica é um processo necrotizante, rapidamente progressivo e potencialmente fatal que envolve o cego, íleon terminal e cólon ascendente.
Mais frequentemente descrita em associação com quimioterapia para neoplasias hematológicas, tem tido um interesse crescente devido à associação com novos esquemas de quimioterapia intensivos para neoplasias sólidas.
Cursa com sintomatologia gastrointestinal inespecífica, sendo a precocidade no diagnóstico e na instituição terapêutica essenciais para a redução da taxa de mortalidade.
Apresenta-se, pela particularidade de ocorrer num doente transplantado hepático, o caso clínico de um doente do sexo masculino, de 54 anos de idade, com o diagnóstico de enterocolite neutropénica tratado com sucesso com terapêutica médica conservadora.
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Summary
Neutropenic enterocolitis is a rapidly progressive and potentially fatal necrotizing process involving the terminal ileum, cecum and ascending colon. Previously it has been described in association with chemotherapy for hematological diseases.
Recently, it has also been observed after several chemotherapy regimens for solid tumors.
It is characterized by non-specific gastrointestinal symptoms. The early diagnosis and treatment are essential to reduce the mortality rate.
We present the unusual case of a 54 year old male patient submitted to liver transplantation who developed neutropenic enterocolitis, which was successfully treated with conservative medical management.
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Bibliografia
1. Debrito D, Barton E, Spears KL, Granmer HH, Karp SJ, Anglin D, et al. Acute right lower quadrant pain in a patient with leukaemia. Annals of Emergency Medicine 1998; vol. 32(1): 98-101. [ Links ]
2. Nadiminti U, Greene JN, Vincent AL, Sandin RL. Tiphlitis in neutropenic patients: An analysis of thirty-nine patients in a cancer hospital. Infectious Diseases in Clinical Practice 2000; 153-160.
3. Otaibi AA, Barker C, Anderson R, Signalet DL, Calgary A. Neutropenic enterocolitis ( typhilitis) after bone marrow transplant. J. Pediatr Surg 2002; 37: 770-772.
4. Song HK, Kreisel D, Canter R, Krupnick AS, Stadtmauer EA, Buzby G. Changing presentation and management of neutropenic enterocolitis. Arch Surg 1998; 133: 979-982.
5. Cunningham SC, Fakhry K, Bass BL, Napolitano LM. Neutropenic enterocolitis in adults: Case series and review of the literature. Digestive Diseases and Sciences 2005; vol. 50, No. 2: 215-220.
]]> 6. Wach M, Dmoszynska A, Wasik-Szczepanek E, Pozarowsky A, Drop A, Szczepanek D. Neutropenic enterocolitis: serious complication during the treatment of acute leukemias. Ann Hematol 2004; 83(8): 522-526.7. Boggio L, Pooley R, Roth SI, Winter JN. Typhilitis complicating autologous blood stem cell transplantation for breast cancer. Bone Marrow Transplantation 2000; vol.25(3): 321-326.
8. Gorschluter M, Mey U, Strehl J, Schmitz V, Rabe C, Pauls K, et al. Invasive fungal infections in neutropenic enterocolitis: a systematic analysis of pathogens, incidence, treatment and mortality in adults patients. BMC Infect Dis 2006; 26: 6-35.
9. Davila ML. Neutropenic enterocolitis. Curr Opin Gastroenterol 2006; 22(1): 44-17 and 9(3): 249-255.
10. Stong HK, Kreisel D, Canter R, Krupnick AS, Stadtmanter EA, Buzby G. Changing presentation and management of neutropenic enterocolitis. Arch Surg 1998; 133(9): 979-982.
11. Frankel AH, Barker F, Williams G, Benjamin IS, Lechler R, Rees AJ. Neutropenic enterocolitis in a renal transplant patient. Transplantation 1991; 52: 913-914.
12. Ehrenstein BP,Mir J, Swan N, Craven DE. Typhilitis (Neutropenic Enterocolitis) in a patient with AIDS: case report and review of the literature. Infectious Diseases in Clinical Practice 1999; 8 (6):312-313.
13. Brenner CT, Monahan BP. Necrotizing enterocolitis in neutropenia and chemoterapy: a clinical update and old lessons relearned. Curr Gastoenterol Rep 2006; 8(4): 333-341.
14. Gorschluter M, Mey U, Strehl J, Zinske C, Schepke M, Schmidt-Wolf IG, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 2005; 75(1): 1-23.
15. Tokar B, Aydogu S, Pasaoglu O, Ilhan H, Kasapoglu E. Neutropenic enterocolitis: is it possible to break vicious circle between neutropenia and the bowel wall inflammation by surgery? Int J Colorectal Dis 2003; 18(5): 455-458.
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* Centro Hospitalar do Alto Ave – Guimarães (Serviço de Gastrenterologia), Portugal.
Correspondência:
Dr. José Cotter
Centro Hospitalar do Alto Ave – Guimarães
Serviço de Gastrenterologia
Rua dos Cutileiros – Creixomil
4810-005 Guimarães
]]> e-mail: jcotter@hguimaraes.min-saude.pt
Recebido para publicação: 18/05/2007
Aceite para publicação: 12/12/2007
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