Acute Abdomen, Bowel/Biliary Obstruction, and Fistula
Summary of Key Points
Gastrointestinal Perforation
• 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.
Gastrointestinal Bleeding
Neutropenic Enterocolitis
• 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.
Bowel and Biliary Obstruction
• 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.
Fistulae
• 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.
