Neutropenic enterocolitis (NE) is a serious complication in neutropenic patients. Once exclusively thought to be found in patients with
leukemia and
lymphoma, it is now being seen with increased frequency during bone marrow transplant,
chemotherapy for solid
tumors, and in patients suffering from
acquired immune deficiency syndrome and
cyclic neutropenia. The pathophysiology of NE is not completely understood, but unquestionably involves
neutropenia, mucosal barrier damage, and
infection resulting in a necrotizing process of the bowel wall. The cecum,
ileus, and ascending colon are most commonly involved. Initial symptoms are usually nonspecific
abdominal pain and
fever. Localized, severe right lower quadrant
pain,
sepsis, and bowel perforation may rapidly develop. Once considered a fatal complication, the outcome for the child with NE has improved with better diagnostic imaging techniques and
antibiotics. Most children can be successfully managed conservatively with early introduction of broad-spectrum
antibiotics and supportive care. However, a significant number will need surgical intervention.
Nursing care of these children requires knowledge of the disease process, excellent clinical assessment skills, and a compassionate, family-centered approach.