„Ostry brzuch” u dziecka z ostrÄ białaczkÄ limfoblastycznÄ jako powikłanie chemioterapii indukcyjnej - opis przypadku

Acute abdominal symptoms occur quite frequently in patients treated for acute lymphoblastic leukemia (ALL). Among the reported reasons for “acute abdomen” in these patients, intussusception is a rare diagnosis. More often, there is an acute pancreatitis (AP) associated with treatment with L-asparaginase (L-ASP). The case report describes a 20-month-old patient, who developed symptoms of acute abdomen at induction therapy of ALL. Ultrasound revealed bleeding in the intestinal wall, which during the day has evolved into an unusual image initially interpreted as volvulus. Laboratory tests showed elevated serum and urine amylase level. The patient was operated on. Multilevel intussusception with segmental intestinal necrosis and acute pancreatitis was diagnosed intraoperatively. The necrotic bowel was resected and ileostomy was performed. The pancreatic area was drained (external drainage). The patient developed necrolysis of pancreas after another 27 days, despite of uncomplicated early postoperative period and withheld chemotherapy. The patient was treated with external drainage of the area of the pancreas for nearly five months. The decision of restoring the ALL treatment was made after six weeks of interruption of ALL treatment, despite of ileostomy and external drainage of pancreatic area. The operation of restoring of the continuity of gastrointestinal tract was delayed in time. The patient remains in complete hematological remission.