Ultrasound findings guided a successful hemicolectomy in a leukemic patient with neutropenic enterocolitis

Abstract

Introduction: Neutropenic enterocolitis (NEC) can be a life-threatening complication of chemotherapy in leukemic patients. Early diagnosis and treatment is therefore crucial.

Methods: A 38-year-old woman with acute lymphoblastic leukemia and chemotherapy-induced neutropenia suddenly developed symptoms suspicious of NEC. Transabdominal ultrasound showed features consistent with NEC, later confirmed by computed tomography (CT) scan.

Results: The patient was scanned using portable ultrasound (US) equipment (Esaote My Lab 25). US findings showed involvement of the cecum, appendix, ascending colon and proximal middle transverse colon, with features resembling gas containing fissures within the colon wall itself. The risk of colon rupture was confirmed by CT scan. The patient underwent successful hemicolectomy after intravenous treatment with broad spectrum antibiotics, granulocyte-colony stimulating factor (G-CSF), platelets and fresh frozen plasma transfusion.

Discussion: A prompt bedside US examination upon development of symptoms allowed an early diagnosis of NEC and identified features consistent with imminent colon wall rupture, shifting the management of this life-threatening complication from medical to surgical. Multidisciplinary intervention was crucial for a successful hemicolectomy in a severely affected neutropenic patient.

Keywords: Enterocolitis; Hemicolectomy; Leukemia; Neutropenic; Ultrasound sonography.

Figures

Fig. 1

US scanning: the colon wall looks severely hypoechoic non-stratified and thickened (11 mm) with loss of the haustral pattern. The lumen is distorted (white arrowheads). There are highly echogenic lines running through the thickened wall consistent with gas containing fissures (black arrowheads).

Fig. 2

CT scan: view of the ascending colon with thickened wall and gas within the wall structure (with arrows).

Fig. 3

Colon showing hemorrhagic necrosis, thickness and congestion of the wall.