Abdominal Pain in Neutropenic Patients

• 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 1.0×109/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.

(Arch Surg. 1990;125:1119-1127)