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                                                                                                   Conference  Proceedings        Neutropaenic  enterocolitis  post  chemotherapy  for   carcinoma  of  the  breast     Background- Neutropaenic enterocolitis (NE) is a life threatening complication

occurring most frequently after intensive chemotherapy in acute leukaemia and solid tumours.

Case report- A 48 year old lady presented with T4N2M0 staged carcinoma of the left breast for which she received Docetaxil and capcetabine as neoadjuvant chemotherapy. Eight days later she presented with fever and severe right lower abdominal pain. On examination she was toxic with a pulse rate of 122/min. BP of 80/60 mm Hg and

respiratory rate of 28/min. Abdominal examination revealed an vague tender mass in

the right iliac fossa. Investigations confirmed absolute neutropaenia ( WBC-3.8 x109//L, total neutrophil count12.3%, neutrophil differential count 0.5x109/L(normal 1 to 4.8

x109/L). An urgent CT scan revealed gross thickening of the caecal and ileal wall with

intramural air (pneumatosis intestinalis) and obliteration of the lumen. After intensive resuscitation with IV fluids and under the cover of tazocin , meropenum and

metronidazole she underwent exploratory laparotomy. The caecum and ileum revealed segmental infarction and she underwent right hemicolectomy with ileostomy and mucous fistula. She however continued to be septicaemic with progressive need of inotropes and eventually succumbed to multiorgan failure

Conclusion- NE remains a major challenge both in terms of diagnosis and management

with increasing use of new, multiple and aggressive chemotherapy in treatment of various malignancies. Fever, abdominal pain and bowel thickening should alert the clinician in a neutropaenic patient.US and CT scan are useful adjuncts for early diagnosis.

Resolution of NE is based on early return of neutrophil count to normal, provision of

broad spectrum antibiotics and bowel rest. Although conservative treatment is often employed with success surgical intervention is required in patients with bleeding,

perforation and failure to respond to conservative management. While without adequate treatment the mortality rate is 50 to 100% with adequate treatment this may be significantly reduced to 23 to 31%