images in haematology
Abdominal compartment syndrome in neutropenic enterocolitis
A 56-year-old woman was admitted to our hospital for the treatment of a recently diagnosed high-risk myelodysplastic syndrome (MDS, refractory anaemia with excess blasts, type 2). Remission induction combination chemotherapy consisted of cytarabine, etoposide and clofarabine. During a period of neutropenia she developed fever, which was initially treated empirically with ceftazidime. However, the fever persisted and she developed abdominal pain, diarrhoea and severe hypoalbuminaemia (albumin 13 g/l), raising the suspicion of neutropenic enterocolitis. Progressive abdominal distension, resulting from exudative ascites, was complicated by the occurrence of acute renal failure, respiratory insufficiency and reduced peripheral circulation (left). Contrast-enhanced computed tomography showed, in addition to ascites, bowel wall thickening, most prominently of the caecum and ascending colon (right). She was transferred to the intensive care unit. A compartment syndrome was suspected, which was supported by an elevated bladder pressure of 28 cm
ª 2012 Blackwell Publishing Ltd British Journal of Haematology, 2013, 160, 273
H2O (normal 10 cm H2O). Drainage of ascitic fluid resulted in improvement of both renal and respiratory failure. Cultures of blood and ascitic fluid revealed Clostridium tertium and Enterococcus faecalis indicative of severe mucositis with subsequent translocation of gut microbes. Peritonitis with massive exudative ascites causing abdominal compartment syndrome is a rare complication of neutropenic enterocolitis following treatment of leukaemia, which should be suspected when abdominal distension is accompanied by renal failure, respiratory distress and circulatory compromise. The treatment of choice is paracentesis to improve systemic circulation even in the context of sepsis. Maarten van Vliet1, Hans J. G. van der Hoeven2 and Walter J. F. M. van der Velden1 Departments of 1Haematology, 2Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands E-mail:
[email protected]
First published online 04 December 2012 doi:10.1111/bjh.12140
