الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chemotherapy-related toxicities commonly involve
the abdomen and may be specific to both the type of malignancy and treatment being used. These complications
can produce CT findings in the hepatobiliary,
gastrointestinal and urinary systems such as pseudo
cirrhosis, hepatic steatosis, pseudo-membranouscolitis,
neutropenicenterocolitis, hemorrhagic cystitis and renal
masses. Recognition of these complications is important to
facilitate the diagnosis and management.
Our aim was to study all abdominal complications
occurring during the course of chemotherapy for childhood
malignancies; in order to define their epidemiologic and
clinical features as well as their predisposing factors. The
study reported our center experience with management and
outcome of these complications for 5 years (from July 2008
to July 2013).
Patients and Methods:
Total number of patients included in the study was 85
patients divided into:
Group 1: 42 patients who develop abdominal
complications after receiving chemotherapy in the past 5
Summary and Conclusion
101
years in Ain Shams University, Children’s Hospital;
including: Enteritis, Neutropenic enterocolitis, Bowel
perforation, Septic peritonitis, Hemorrhagic cystitis, GB
inflammation and GB stones.
Group 2: 43 patients who did not develop abdominal
complications after receiving chemotherapy as a disease
control group.
Exclusion of patients who did not complete their
chemotherapy or had incomplete records
The medical records of patients were reviewed and a
standardized data sheet was completed for all study
subjects. The collected data include:
History: Demograhic data: Sex of patients and age
at diagnosis of cancer, Diagnosis and type of cancer,
Protocol of chemotherapy, The presence of risk
factors as mucositis, neutropenia, poor nutrition
(low BMI), Presence of fungal pulmonary or
hepatosplenic infection, Type of abdominal
complications: Enteritis, Neutropenic enterocolitis,
Bowel perforation, Septic peritonitis, Hemorrhagic
cystitis, GB inflammation and GB stones, Timing of
complication in relation to chemotherapy.
Summary and Conclusion
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Reporting clinical examination with special
consideration for:
Weight, height, body mass index, Symptoms and
signs of each complication as fever, nausea, vomiting,
diarrhea, abdominal pain, tenderness, distension, Dysuria,
hematuria, jaundice and septic shock
Reporting the laboratory results:
Blood picture and type of culture performed and the
offending organism Reporting the results of imaging; US and/or CT findings Reporting the treatment: antimicrobial treatment and/or surgical treatment
Reporting the final outcome
Results:
Our results included 85 children with cancer under
chemotherapy with age ranged from 6 months to 17 years
and with Median (interquartile range) 4(4); they were 40
females (47.1%) and 45 males (52.9%). They were divided
into two groups: Group 1: 42 patients with age ranged from
7 months to 17 years and with Median (interquartile range)
4.00(5.50). They were 18 females (42.9%) and 24 males
Summary and Conclusion
103
(57.1%). Group 2: 43 patients with age ranged from 6
months to 15 years and with Median (interquartile range)
4.500(3.00). They were 22 females (51.2%) and 21 males
(48.8%).
Regarding malignancy diagnosis in our results,
ALL was present in (49.9%), AML in (5.9%), burkitt
lymphoma in (17.6%), lymphoblastic lymphoma in (7.1%),
neuroblastoma in (9.4%), wilms tumour in (4.7%) and
Langerhans Cells Histocytosis (LCH) in (5.9%).
Regarding chemotherapeutic agents use, the most
frequently used were: vincristine (62.4%), L-asparaginase
(56.5%), ITTT (35.3%), dexamethasone (34.1%),
Methotrexate 31.8% AraC (30.6%) and prednisone
(30.6%).
The prevalence of abdominal complications in our
study was 49.4%. They included: enteritis (24.7%),
netropenic enterocolitis (9.4%), bowel perforation (5.9%),
hemorrhagic cystitis (5.9%) and gall bladder inflammation
and stone (3.5%).
As regard clinical presentation 24.7%of patients
who develop abdominal complications had fever, nausea,
vomiting and diarrhea, 10.6% had fever, abdominal pain,
tenderness and distension, 5.9% had abdominal pain,
vomiting, dysuria and hematuria, 5.9% had septic shock
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and 2.4% had fever, abdominal pain, tenderness and
jaundice.
Regarding studied risk factors, 49.4% had
mucositis, 35.3% had poor nutrition (low BMI), 9.4% had
HCV infection and 4.7% had possible fungal lung
infection.
Frequent neutropenia (less than 1500 cells/μL) was
reported in all patients (100%) during the treatment course.
By radiologic (US/ CT) evaluation among patients
who developed abdominal complications, 16.6% had ascitis
and pneumatosis intestinalis, 11.9% had Ascitis,
pneumoperitonium and hepatomegaly, 11.9% had ascitis,
7.14% had hepatomegaly, gall bladder mud and GB
stones, 2.3% had ascitis, pneumatosis intestinalis and
hepatomegaly and 7.14% had hepatomegaly.
Regarding microbial complications among patients
who developed abdominal complications: 28.8% did blood
culture and 7.14% did ascitic fluid culture, 23.8% had
klebsiella and 11.9% had acinetobacter infection.
Regarding treatment and outcome of the studied
patients who developed abdominal complications, 95.2%
received antimicrobial treatment and 4.8% received
antimicrobial and surgical treatment.
Summary and Conclusion
105
Regarding the outcome, 90.5% improved and 9.5%
died.
No statistically significant difference found between
group 1and group2 regarding sex and age.
Significant lower median weight for age (SDS) and
median BMI in patients in group 2 compared to patients in
group 1, while no significant difference in median height
for age (SDS) was found between both study groups.
No statistically significant difference found between
the study groups regarding the original diagnosis or the
chemotherapeutic agents use.
There was a statistically significant higher frequency
of mucositis & hepatosplenic infection (HCV) in group1
compared to group2 while there is no statistically
significance regarding poor nutrition (low BMI) and
possible fungal lung infection between the study groups