الفهرس | Only 14 pages are availabe for public view |
Abstract Chemotherapy-related toxicities commonly involve the abdomen and may be specific to both the type of malignancy and treatment being used. These complications can produce CT findings in the hepatobiliary, gastrointestinal and urinary systems such as pseudo cirrhosis, hepatic steatosis, pseudo-membranouscolitis, neutropenicenterocolitis, hemorrhagic cystitis and renal masses. Recognition of these complications is important to facilitate the diagnosis and management. Our aim was to study all abdominal complications occurring during the course of chemotherapy for childhood malignancies; in order to define their epidemiologic and clinical features as well as their predisposing factors. The study reported our center experience with management and outcome of these complications for 5 years (from July 2008 to July 2013). Patients and Methods: Total number of patients included in the study was 85 patients divided into: Group 1: 42 patients who develop abdominal complications after receiving chemotherapy in the past 5 Summary and Conclusion 101 years in Ain Shams University, Children’s Hospital; including: Enteritis, Neutropenic enterocolitis, Bowel perforation, Septic peritonitis, Hemorrhagic cystitis, GB inflammation and GB stones. Group 2: 43 patients who did not develop abdominal complications after receiving chemotherapy as a disease control group. Exclusion of patients who did not complete their chemotherapy or had incomplete records The medical records of patients were reviewed and a standardized data sheet was completed for all study subjects. The collected data include: History: Demograhic data: Sex of patients and age at diagnosis of cancer, Diagnosis and type of cancer, Protocol of chemotherapy, The presence of risk factors as mucositis, neutropenia, poor nutrition (low BMI), Presence of fungal pulmonary or hepatosplenic infection, Type of abdominal complications: Enteritis, Neutropenic enterocolitis, Bowel perforation, Septic peritonitis, Hemorrhagic cystitis, GB inflammation and GB stones, Timing of complication in relation to chemotherapy. Summary and Conclusion 102 Reporting clinical examination with special consideration for: Weight, height, body mass index, Symptoms and signs of each complication as fever, nausea, vomiting, diarrhea, abdominal pain, tenderness, distension, Dysuria, hematuria, jaundice and septic shock Reporting the laboratory results: Blood picture and type of culture performed and the offending organism Reporting the results of imaging; US and/or CT findings Reporting the treatment: antimicrobial treatment and/or surgical treatment Reporting the final outcome Results: Our results included 85 children with cancer under chemotherapy with age ranged from 6 months to 17 years and with Median (interquartile range) 4(4); they were 40 females (47.1%) and 45 males (52.9%). They were divided into two groups: Group 1: 42 patients with age ranged from 7 months to 17 years and with Median (interquartile range) 4.00(5.50). They were 18 females (42.9%) and 24 males Summary and Conclusion 103 (57.1%). Group 2: 43 patients with age ranged from 6 months to 15 years and with Median (interquartile range) 4.500(3.00). They were 22 females (51.2%) and 21 males (48.8%). Regarding malignancy diagnosis in our results, ALL was present in (49.9%), AML in (5.9%), burkitt lymphoma in (17.6%), lymphoblastic lymphoma in (7.1%), neuroblastoma in (9.4%), wilms tumour in (4.7%) and Langerhans Cells Histocytosis (LCH) in (5.9%). Regarding chemotherapeutic agents use, the most frequently used were: vincristine (62.4%), L-asparaginase (56.5%), ITTT (35.3%), dexamethasone (34.1%), Methotrexate 31.8% AraC (30.6%) and prednisone (30.6%). The prevalence of abdominal complications in our study was 49.4%. They included: enteritis (24.7%), netropenic enterocolitis (9.4%), bowel perforation (5.9%), hemorrhagic cystitis (5.9%) and gall bladder inflammation and stone (3.5%). As regard clinical presentation 24.7%of patients who develop abdominal complications had fever, nausea, vomiting and diarrhea, 10.6% had fever, abdominal pain, tenderness and distension, 5.9% had abdominal pain, vomiting, dysuria and hematuria, 5.9% had septic shock Summary and Conclusion 104 and 2.4% had fever, abdominal pain, tenderness and jaundice. Regarding studied risk factors, 49.4% had mucositis, 35.3% had poor nutrition (low BMI), 9.4% had HCV infection and 4.7% had possible fungal lung infection. Frequent neutropenia (less than 1500 cells/μL) was reported in all patients (100%) during the treatment course. By radiologic (US/ CT) evaluation among patients who developed abdominal complications, 16.6% had ascitis and pneumatosis intestinalis, 11.9% had Ascitis, pneumoperitonium and hepatomegaly, 11.9% had ascitis, 7.14% had hepatomegaly, gall bladder mud and GB stones, 2.3% had ascitis, pneumatosis intestinalis and hepatomegaly and 7.14% had hepatomegaly. Regarding microbial complications among patients who developed abdominal complications: 28.8% did blood culture and 7.14% did ascitic fluid culture, 23.8% had klebsiella and 11.9% had acinetobacter infection. Regarding treatment and outcome of the studied patients who developed abdominal complications, 95.2% received antimicrobial treatment and 4.8% received antimicrobial and surgical treatment. Summary and Conclusion 105 Regarding the outcome, 90.5% improved and 9.5% died. No statistically significant difference found between group 1and group2 regarding sex and age. Significant lower median weight for age (SDS) and median BMI in patients in group 2 compared to patients in group 1, while no significant difference in median height for age (SDS) was found between both study groups. No statistically significant difference found between the study groups regarding the original diagnosis or the chemotherapeutic agents use. There was a statistically significant higher frequency of mucositis & hepatosplenic infection (HCV) in group1 compared to group2 while there is no statistically significance regarding poor nutrition (low BMI) and possible fungal lung infection between the study groups |