Chapter 47 • Perforation affects approximately 20% of patients with acute abdominal emergencies. • Bowel perforation can be due to spontaneous tumor rupture, tumor necrosis secondary to chemotherapy, radiation therapy, drugs (e.g., steroids), or inflammatory conditions. • Operative intervention is mandated unless the patient’s overall prognosis is poor. • Also termed necrotizing enterocolitis, neutropenic enterocolitis typically affects the terminal ileum, cecum, and ascending colon in patients with chemotherapy-induced neutropenia. • Most patients respond to conservative management with broad-spectrum antibiotics and bowel rest. • Surgical intervention should be considered for perforation, uncontrolled sepsis, or persistence of symptoms despite correction of neutropenia. • Obstruction affects approximately 40% of patients with cancer who experience acute abdominal emergencies. • One fourth to one third of patients who require surgical intervention have a benign cause of their obstruction. • Partial bowel obstruction can initially be treated nonoperatively, which is successful 25% of the time. • Cross-sectional imaging gives valuable information about the location and etiology of malignant biliary obstruction and resectability of tumor. • Manifesting symptoms rarely match those of intraabdominal malignancy and more commonly represent complications after surgery or radiation therapy or both. • Medical management consisting of nutritional support and bowel rest allows spontaneous closure of most enterocutaneous fistulas.
Acute Abdomen, Bowel/Biliary Obstruction, and Fistula
Summary of Key Points
Gastrointestinal Perforation
Gastrointestinal Bleeding
Neutropenic Enterocolitis
Bowel and Biliary Obstruction
Fistulae
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Acute Abdomen, Bowel/Biliary Obstruction, and Fistula
