Neutropenic enterocolitis (NEC) is a life-threatening disease with substantial morbidity and mortality, seen primarily in patients with
hematologic malignancies. The frequency of NEC has increased with the widespread use of chemotherapeutic agents such as the
taxanes, which cause severe gastrointestinal
mucositis. Neutropenic patients with
fever and abdominal symptoms (cramping,
pain, distention,
diarrhea, GI
bleeding), should undergo evaluation of the abdomen for bowel wall thickening of >4 mm, the hallmark of NEC.
Clostridium difficile infection should be ruled out, as well as other etiologies such as
graft-versus-host disease. Complications include
bacteremia, which is often polymicrobial,
hemorrhage, and bowel wall perforation/
abscess formation. Management includes bowel rest, correction of cytopathies and coagulopathies, and broad spectrum
antibiotics and
antifungal agents. Surgical intervention may be necessary to manage complications such as
hemorrhage and perforation and should be delayed, if possible, until recovery from
neutropenia.