Category: Emergencies
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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…