Neutropenic necrotizing enterocolitis: A life-threatening complication after aggressive chemotherapy for leukemia

Neutropenic enterocolitis can occur after aggressive chemotherapy with a wide range of severity from mild to life threatening. Neutropenic necrotizing enterocolitis (NNE) is a catastrophic condition that has rarely been discussed in the literature. Here, we present the case of a 27-year-old previously healthy female who was diagnosed with acute myeloid leukemia and underwent a first course of chemotherapy. Severe neutropenia, high fever, and abdominal pain were noted 5 days later. After medical treatment had failed, emergent laparotomy was performed. Several patches of transmural necrosis were seen at the jejunum, and resection with primary anastomosis was done. However, more newly formed necrotic patches were found over the small bowel during second-look surgery 2 days later. This report emphasizes that NNE is an irreversible ongoing process refractory to medical or surgical treatments, and physicians should be cautious of this syndrome when using aggressive chemotherapy.