Abdominal pain in neutropenic patients
D. S. Wade, H. Douglass Jr, H. R. Nava and M. Piedmonte
Department of Surgical Oncology, Roswell Park Memorial Institute, Buffalo, NY.
The records of 50 patients with abdominal pain and severe neutropenia were
retrospectively reviewed to identify factors that may have influenced
survival and surgical decisions. Ninety-two percent of these patients had
hematologic malignant neoplasms. The patients were divided into four
groups: 23 treated nonsurgically who died in the hospital, 10 treated
nonsurgically who survived, 10 treated surgically who survived, and 7
treated surgically who died. Abdominal distention was the only symptom or
sign found to be associated with mortality. Ninety-five percent of
survivors recovered their white blood cell count above 1.0 x 10(9)/L, while
70% of nonsurvivors did not. No symptom or sign was found to be pivotal in
the decision for or against surgical intervention. Overall, 60% of the
patients in this series died. Thirty-four percent of patients underwent a
surgical procedure, the majority of whom survived. We designed an algorithm
for the evaluation and treatment of neutropenic patients with abdominal
pain.