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.
- NEC excluded: Patients having any of the gastrointestinal
symptoms but no abnormal findings on physical examination (tenderness,
rebound tenderness, rigidity) and no radiological abnormality
- Probable NEC: Patients with gastrointestinal symptoms and
also having any one/more of abnormal physical findings but no
radiological abnormality/ imaging not done
- 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.