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Devarapalli UV, Sarma MS, Mathiyazhagan G. Gut and liver involvement in pediatric hematolymphoid malignancies. World J Gastrointest Oncol 2022; 14:587-606. [PMID: 35321282 PMCID: PMC8919016 DOI: 10.4251/wjgo.v14.i3.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/22/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Hematolymphoid malignancies are common neoplasms in childhood. The involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum are closely interlinked and commonly encountered. In leukemias, lymphomas, and Langerhans cell histiocytosis (LCH), the manifestations result from infiltration, compression, overwhelmed immune system, and chemotherapy-induced drug toxicities. In acute leukemias, major manifestations are infiltrative hepatitis, drug induced gastritis, neutropenic typhlitis and chemotherapy related pancreatitis. Chronic leukemias are rare. Additional presentation in lymphomas is cholestasis due to infiltration or biliary obstruction by lymph nodal masses. Presence of ascites needs a thorough workup for the underlying pathophysiology that may modify the therapy and affect the outcome. Uncommon hematolymphoid malignancies are primary hepatic, hepatosplenic, and GI lymphomas which have strict definitions. In advanced diseases with extensive spread, it may be impossible to distinguish these diseases from the primary site of origin. LCH produces biliary strictures that mimic as sclerosing cholangitis. Liver infiltration is associated with poor liver recovery even after chemotherapy. The heterogeneity of gut and liver manifestations in hematolymphoid malignancies has a clinical impact on their management. Though chemotherapy is the mainstay of therapy in all hematolymphoid malignancies, debulking surgery and radiotherapy have an adjuvant role in specific clinical scenarios. Rare situations presenting as liver failure or end-stage liver disease require liver transplantation. At their initial presentation to a primary care physician, given the ambiguity in clinical manifestations and the prognostic difference with time-bound management, it is vital to recognize them early for optimal outcomes. Pooled data from robust registries across the world is required for better understanding of these complications.
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Affiliation(s)
- Umeshreddy V Devarapalli
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Moinak S Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Gopinathan Mathiyazhagan
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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Kapandji N, Azoulay E, Zafrani L. Recent advances in neutropenic enterocolitis: Insights into the role of gut microbiota. Blood Rev 2022. [DOI: 10.1016/j.blre.2022.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
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Reyes JVM, Syed SB, Seen T, Sheth N, Kowalczyk C. Typhlitis: A Rare Appendicitis Mimic in a Young Healthy Female. Cureus 2021; 13:e15839. [PMID: 34322332 PMCID: PMC8298106 DOI: 10.7759/cureus.15839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
Typhlitis, also known as neutropenic enterocolitis, is a rare but serious condition characterized by inflammation of the cecum causing right lower quadrant (RLQ) pain and fever. It typically affects immunocompromised patients with neutropenia, hematologic malignancies, AIDS, or those on immunosuppressive therapy. This is an entity that should be considered in any differential for a patient with febrile RLQ pain, not just those with obvious immunosuppression.
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Affiliation(s)
- Jonathan Vincent M Reyes
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Salman B Syed
- Internal Medicine, University of Illinois College of Medicine, Peoria, USA
| | - Tasur Seen
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Nirali Sheth
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Christopher Kowalczyk
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
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Rosano N, Gallo L, Mercogliano G, Quassone P, Picascia O, Catalano M, Pesce A, Fiorini V, Pelella I, Vespere G, Romano M, Tammaro P, Marra E, Oliva G, Lugarà M, Scuderi M, Tamburrini S, Marano I. Ultrasound of Small Bowel Obstruction: A Pictorial Review. Diagnostics (Basel) 2021; 11:diagnostics11040617. [PMID: 33808245 PMCID: PMC8065936 DOI: 10.3390/diagnostics11040617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
Abstract
Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial imaging modality for assisting physicians in the rapid and accurate diagnosis of a variety of pathologies to expedite management. In the case of SBO diagnosis, ultrasound has an overall sensitivity of 92% (95% CI: 89–95%) and specificity of 93% (95% CI: 85–97%); the aim of this review is to examine the criteria for the diagnosis of SBO by ultrasound, which can be divided into diagnostic and staging criteria. The diagnostic criteria include the presence of dilated loops and abnormal peristalsis, while the staging criteria are represented by parietal and valvulae conniventes alterations and by the presence of free extraluminal fluid. Ultrasound has reasonably high accuracy compared to computed tomography (CT) scanning and may substantially decrease the time to diagnosis; moreover, ultrasound is also widely used in the monitoring and follow-up of patients undergoing conservative treatment, allowing the assessment of loop distension and the resumption of peristalsis.
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Affiliation(s)
- Nicola Rosano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
- Correspondence: (N.R.); (S.T.)
| | - Luigi Gallo
- Department of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (L.G.); (P.Q.); (O.P.)
| | - Giuseppe Mercogliano
- Department of Radiology, University of Naples “Federico II”, 80131 Napoli, Italy;
| | - Pasquale Quassone
- Department of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (L.G.); (P.Q.); (O.P.)
| | - Ornella Picascia
- Department of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (L.G.); (P.Q.); (O.P.)
| | - Marco Catalano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Antonella Pesce
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Valeria Fiorini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Ida Pelella
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
| | - Giuliana Vespere
- Department of Gastroenterology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy;
| | - Marina Romano
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.R.); (P.T.)
| | - Pasquale Tammaro
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.R.); (P.T.)
| | - Ester Marra
- Department of Surgery, University of Naples “Federico II”, 80131 Napoli, Italy;
| | - Gabriella Oliva
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (G.O.); (M.L.)
| | - Marina Lugarà
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (G.O.); (M.L.)
| | - Mario Scuderi
- Department of Emergency A.O.E. Cannizzaro, 95126 Catania, Italy;
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
- Correspondence: (N.R.); (S.T.)
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, 80147 Napoli, Italy; (M.C.); (A.P.); (V.F.); (I.P.); (I.M.)
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Vizuete del Río J, Martín Benítez G, Ripollés González T, Merino Bonilla J, San-miguel T. Bowel ultrasonography in acute abdomen: Beyond acute appendicitis. Radiología (English Edition) 2021; 63:193-205. [DOI: 10.1016/j.rxeng.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vizuete Del Río J, Martín Benítez G, Ripollés González T, Merino Bonilla JA, San-Miguel T. Bowel ultrasonography in acute abdomen: beyond acute appendicitis. Radiologia (Engl Ed) 2021; 63:193-205. [PMID: 33551121 DOI: 10.1016/j.rx.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/03/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
Acute abdomen is a common reason for consultation in the emergency department. A broad spectrum of entities, including diverse diseases of the gastrointestinal tract, can cause acute abdomen. Although computed tomography is the technique most widely used to evaluate acute abdomen in the emergency department, abdominal ultrasound is often performed first and allows bowel disease to be suspected. This article describes the ultrasound features of diverse bowel diseases that can cause acute abdomen, such as acute diverticulitis, bowel obstruction, gastrointestinal perforation, bowel ischemia, intraabdominal fat necrosis, and miscellaneous processes such as endometriosis, foreign bodies, or vasculitis. Radiologists must be familiar with the different features of abnormal bowel that can be detected incidentally in patients without clinical suspicion of bowel disease. This article focuses on ultrasonographic signs of bowel disease; other articles in this series cover the ultrasonographic signs of acute appendicitis, inflammatory bowel disease, and infectious diseases.
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Affiliation(s)
- J Vizuete Del Río
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - G Martín Benítez
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - T Ripollés González
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - J A Merino Bonilla
- Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, España.
| | - T San-Miguel
- Departamento de Anatomía Patológica, Facultad de Medicina, Universidad de Valencia, Valencia, España
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McGinty K. Acute Abdomen in the Oncology Patient. Semin Roentgenol 2020; 55:400-416. [PMID: 33220786 DOI: 10.1053/j.ro.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katrina McGinty
- Department of Radiology, UNC School of Medicine, Chapel Hill, NC.
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Ramzee AF, Sameer M, Khan MB, Muhammad Ali S, Zarour A. Combination of Common Problem in a Rare Disease: Right Iliac Fossa Pain in a Chronic Myeloid Leukemia Patient. Cureus 2020; 12:e11523. [PMID: 33354467 PMCID: PMC7746320 DOI: 10.7759/cureus.11523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abdominal symptoms in patients with hematological malignancies can occur due to an array of pathologies. Two diagnoses with similar presentation albeit, generally opposite treatment modalities, are typhlitis (inflammation of cecum) and acute appendicitis. Both diagnoses have to be kept in mind in such a patient presenting with right lower quadrant (RLQ) pain. Sagacious clinical judgment along with the aid of radiological imaging may help in differentiating between the two conditions. We present a case of a young male with chronic myeloid leukemia (CML) on imatinib, diagnosed and started on therapy four years earlier, who presented with symptoms of RLQ pain not typical of acute appendicitis. The accurate diagnosis was made with the assistance of ultrasound (US) imaging and prompt surgical therapy was instituted followed by a smooth postoperative recovery.
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Affiliation(s)
| | | | | | - Syed Muhammad Ali
- Surgery, Weill-Cornell Medical School, Doha, QAT.,Acute Care Surgery, Hamad General Hospital, Doha, QAT
| | - Ahmad Zarour
- Acute Care Surgery, Hamad Medical Corporation, Doha, QAT
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Cherri S, Prochilo T, Rota L, Mutti S, Garatti M, Liserre B, Zaniboni A. Neutropenic Enterocolitis in the Treatment of Solid Tumors: A Case Report and Review of the Literature. Case Rep Oncol 2020; 13:442-448. [PMID: 32399014 PMCID: PMC7204860 DOI: 10.1159/000506896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Neutropenic enterocolitis is a clinical condition characterized by inflammation of the colic mucosa, usually the caecum, associated with bowel wall thickening in patients with compromised immune system due to chemotherapy treatments. It can occur as well in other clinical conditions that lead to immunosuppression. Clinically, patients present with abdominal pain, fever, and neutropenia on blood tests. A number of major and minor criteria have been suggested for the clinical diagnosis of typhlitis. The most sensitive radiological investigation is represented by a computed tomography scan. There are no guidelines for treatment, but some factors may lead the clinician to medical treatments or prompt surgery as the best choice in that particular patient. The most implicated chemotherapeutic regimens are those based on taxanes. Here, we present a clinical case of a young patient with breast cancer and a review of the state of the art of knowledge regarding neutropenic enterocolitis in adult patients undergoing chemotherapy for the treatment of solid tumors.
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Affiliation(s)
- Sara Cherri
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Tiziana Prochilo
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Luigina Rota
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Stefano Mutti
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Barbara Liserre
- Department of Pathology, Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
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