Antineoplastics
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Reactions 1346 - 9 Apr 2011 S Antineoplastics Jejunal stricture in a child: case report A 5-year-old boy developed a jejunal stricture during treatment with antineoplastics for high-grade B-cell non- Hodgkin’s lymphoma (NHL). The boy began treatment according to the NHL-Berlin- Frankfurt-M¨ unster 90 short-pulse chemotherapy protocol [drug details not stated] * ; complications included grade 3 mucositis and febrile neutropenia. Complete remission was documented after two cycles of chemotherapy. However, a CT scan revealed dilated jejunal loops with no visible bowel mass or stricture. He demonstrated symptoms of subacute intestinal obstruction, including constipation, vomiting and abdominal distension with occasional pain. Dilated small bowel loops with short segment narrowing in the distal jejunum were seen on a barium meal follow through. An exploratory laparotomy was performed, which showed a 1cm stricture in the distal jejunum and a band of adhesion at the antimesenteric side, with dilation and hypertrophy of proximal jejunal loops. The man underwent surgical resection of the stricture with end-to-end anastomosis of the jejunal loops. Histopathological analysis of the resected specimen revealed a 1cm stricture with significant infiltration. His symptoms resolved completely following surgery and he continued to receive chemotherapy. Author comment: "The pathophysiology of postchemotherapy esophagitis is complex and is probably an extension of the mucositis associated with chemotherapy. Antineoplastic drugs such as doxorubicin, methotrexate, and cytosine arabinoside induce severe perturbations in the cell cycle and have a particularly severe effect on the rapidly proliferating cells lining the gastrointestinal tract." * The NHL-Berlin-Frankfurt-M¨ unster 90 short-pulse chemotherapy protocol contains various drugs, including doxorubicin, methotrexate and cytarabine [cytosine arabinoside]. Gupta G, et al. Jejunal stricture: A rare complication of chemotherapy in pediatric gastrointestinal B-cell non-hodgkin lymphoma. Journal of Pediatric Hematology/ Oncology 33: e69-e71, No. 2, Mar 2011. Available from: URL: http:// dx.doi.org/10.1097/mph.0b013e3181ef0402 - India 803052168 1 Reactions 9 Apr 2011 No. 1346 0114-9954/10/1346-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1346 - 9 Apr 2011
SAntineoplastics
Jejunal stricture in a child: case reportA 5-year-old boy developed a jejunal stricture during
treatment with antineoplastics for high-grade B-cell non-Hodgkin’s lymphoma (NHL).
The boy began treatment according to the NHL-Berlin-Frankfurt-Munster 90 short-pulse chemotherapy protocol[drug details not stated]*; complications included grade 3mucositis and febrile neutropenia. Complete remissionwas documented after two cycles of chemotherapy.However, a CT scan revealed dilated jejunal loops with novisible bowel mass or stricture. He demonstratedsymptoms of subacute intestinal obstruction, includingconstipation, vomiting and abdominal distension withoccasional pain. Dilated small bowel loops with shortsegment narrowing in the distal jejunum were seen on abarium meal follow through. An exploratory laparotomywas performed, which showed a 1cm stricture in the distaljejunum and a band of adhesion at the antimesenteric side,with dilation and hypertrophy of proximal jejunal loops.
The man underwent surgical resection of the stricturewith end-to-end anastomosis of the jejunal loops.Histopathological analysis of the resected specimenrevealed a 1cm stricture with significant infiltration. Hissymptoms resolved completely following surgery and hecontinued to receive chemotherapy.
Author comment: "The pathophysiology ofpostchemotherapy esophagitis is complex and is probably anextension of the mucositis associated with chemotherapy.Antineoplastic drugs such as doxorubicin, methotrexate, andcytosine arabinoside induce severe perturbations in the cellcycle and have a particularly severe effect on the rapidlyproliferating cells lining the gastrointestinal tract."
* The NHL-Berlin-Frankfurt-Munster 90 short-pulsechemotherapy protocol contains various drugs, includingdoxorubicin, methotrexate and cytarabine [cytosine arabinoside].
Gupta G, et al. Jejunal stricture: A rare complication of chemotherapy in pediatricgastrointestinal B-cell non-hodgkin lymphoma. Journal of Pediatric Hematology/Oncology 33: e69-e71, No. 2, Mar 2011. Available from: URL: http://dx.doi.org/10.1097/mph.0b013e3181ef0402 - India 803052168
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Reactions 9 Apr 2011 No. 13460114-9954/10/1346-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
