Author: Ehab Hanafy
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Perirectal Abscess/Cholecystitis/Veno-Occlusive Disease
In pediatric oncology, certain emergencies require immediate attention due to their complex nature and potential for rapid deterioration. Perirectal abscess, a painful and potentially serious infection near the rectum, poses a significant risk of sepsis. Cholecystitis, or inflammation of the gallbladder, can occur due to various factors, including complications from cancer therapy. Veno-occlusive disease (VOD),…
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Gastro-Intestinal Obstruction
GI tract obstruction, pseudo-obstruction and ileus are infrequent entities in children with cancer. Although GI obstruction from primary cancer is rare in children, it is the initial symptom of Burkitt’s lymphoma in 15% to 25% of abdominal localizations. This may be suspected in cases of intussusception in older children or its recurrence; surgical intervention is…
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Gastro-Intestinal Haemorrhage
GI haemorrhage require prompt diagnosis and treatment, which can eventually include surgical interventions. Haemorrhage in immunocompromised patients may result from different aetiologies. Mucosal ulceration, gastritis or esophagitis are frequent causes of bleeding, provoked by oesophageal varices associated with portal hypertension or Mallory-Weiss caused by repeated emesis. Necrotizing pancreatitis can also explain bleeding. Primary GI tumors can…
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Pancreatitis
Pancreatitis represents a rare but well-known complication of multiple chemotherapeutic agents, most notably asparaginase, steroids, mercaptopurine and cytarabine. L-asparaginase and PEG-asparaginase derived from E. coli are well described for inducing acute pancreatitis of all degrees of severity with a reported incidence of 2–18 %. Clinical picture Classically the pain is epigastric, of sudden onset, gradually intensifying,…
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Typhlitis
Neutropenic enterocolitis refers to necrotizing inflammation of the small or large intestine that occurs in the setting of neutropenia. Typhlitis specifically refers to necrotizing inflammation of the cecum, the most commonly affected bowel segment. Typhlitis is an oncologic emergency because it may lead to bowel obstruction or perforation requiring surgical intervention. Surgery team should be…
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Hyperleukocytosis
Hyperleukocytosis (HL) is defined as a total white cell count greater than 100,000/mm3. Hyperleukocytosis is seen at presentation in 9-13% of children with acute lymphocytic leukemia (ALL) and 5-22% of children with acute myeloid leukemia (AML). It occurs in an even higher percentage of patients with chronic myeloid leukemia (CML). Patients with HL are at…
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Tumor Lysis Syndrome
Tumor lysis syndrome (TLS) is a major onco-metabolic entity in cancer patients, requiring emergency diagnosis and management. TLS can lead to severe renal impairment, cardiac arrhythmias, central nervous system toxicity, and death. Cellular death, either spontaneously or mediated by cancer treatment causes the release of potassium, phosphorus, and uric acid from rapidly dividing malignant cells…
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Central Line Care and Management
A central venous access, or central line (CL), is a device inserted through a vein with the catheter tip positioned in a central vein, typically the superior vena cava or the caval atrial junction. It provides reliable access to the central venous system, and its placement is verified by radiographic studies during and after insertion.…
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Chemotherapeutic Toxicities
Neurotoxicity Ifosfamide Ifosfamide is a nitrogen mustard derivative that acts as a DNA alkylation agent. It is commonly used in solid and hematologic malignancies. Neurotoxicity with ifosfamide is common, occurring in 5-40% of patients, especially with higher doses. Neurotoxicity frequently occurs during the course of treatment and presents as: The onset of symptoms is acute, presenting within…