II. Epidemiology

  1. Rare, but catastrophic cause of Acute Abdominal Pain in patients on Chemotherapy

III. Pathophysiology

  1. Results from Chemotherapy-induced GI mucosa toxicity (and Neutropenia) with subsequent superinfection
  2. Necrotizing colitis involving cecum (but can also affect Large Bowel and proximal Small Bowel)
  3. Similar process as with Necrotizing Enterocolitis in newborns

IV. Risk Factors

VI. Signs

  1. Typical presentation is with a toxic or septic, ill appearing patient
  2. Abdominal Distention

VII. Differential Diagnosis

VIII. Imaging

  1. Abdominal CT
    1. Bowel wall thickening and intramural edema (infarcted bowel)
  2. Avoid tests which risk colon perforation
    1. Barium Enema
    2. Endoscopy

IX. Management

  1. Emergency Surgical Consultation for perforation
    1. Surgical management is based on size of infarcted bowel
  2. Supportive care
  3. Bowel rest
    1. Consider Total Parenteral Nutrition
  4. Broad spectrum IV antibiotics (to cover Gram Negative and Anaerobic Bacteria)
    1. First-Line Agents
      1. Piperacillin-Tazobactam (Zosyn) 4.5 g IV every 6 hours OR
      2. Imipenem-Cilastin 500 mg IV every 6 hours OR
      3. Meropenem 2 g IV every 8 hours
    2. Alternative Agents
      1. Cefepime 2 g IV every 8 hours AND
      2. Metronidazole 500 mg IV every 8 hours
    3. Additional agents to consider in refractory cases
      1. Candida coverage (e.g. echinocandin)
      2. Clostridium difficile coverage (test in all cases)

X. Prognosis

  1. High mortality

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