September 1990

Abdominal Pain in Neutropenic Patients

Author Affiliations

From the Department of Surgical Oncology (Drs Douglass and Nava) and Biomathematics (Ms Piedmonte), Roswell Park Memorial Institute, Buffalo, NY, and the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Wade). Dr Wade is now with the Department of Surgery, US Naval Hospital, San Diego, Calif.

Arch Surg. 1990;125(9):1119-1127. doi:10.1001/archsurg.1990.01410210045006

• 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)