Definitions
Neutropenic enterocolitis :
There is no standardized definition for NEC with wide variability in the definition across the studies.8-11 All neutropenic cancer patients with gastrointestinal symptoms (pain abdomen, vomiting, loose stools, blood in stools or abdominal distension) were eligible for evaluation into the study. We planned to classify these patients into three groups i). NEC excluded ii.) probable NEC and iii.) definite NEC. This was done after other causes like pancreatitis, gastritis and ileus due to metabolic derangements like hypokalemia were ruled out and there was persistence of symptoms beyond 48 hours.
  1. NEC excluded: Patients having any of the gastrointestinal symptoms but no abnormal findings on physical examination (tenderness, rebound tenderness, rigidity) and no radiological abnormality
  2. Probable NEC: Patients with gastrointestinal symptoms and also having any one/more of abnormal physical findings but no radiological abnormality/ imaging not done
  3. Definite NEC : Patients having neutropenia any of the gastrointestinal symptoms, with abnormal findings on physical examination and positive radiological criteria.
Both probable & definite NEC were considered as NEC for this study.
Radiological criteria : Patients with suspected NEC satisfying entry criteria underwent CECT abdomen. Findings (one/more) suggestive of NEC served as radiological criteria- bowel wall thickening > 3mm, abnormal bowel dilatation, pneumatosis intestinalis or free intraabdominal gas.
Acute pancreatitis: Any two of three features- characteristic pain abdomen, elevation of amylase > 3 times upper normal limit and compatible imaging finding, based on modified Atlanta classification29.
Acute gastritis : Characteristic pain abdomen in epigastrium or umbilical region, responding to proton pump inhibitors and no subsequent recurrence of pain.