INTRODUCTION:: INTRODUCTION::Despite the use of new, effective drugs, the disseminated invasive aspergillosis often remains lethal in neutropenic patients. Diagnosis is difficult because early symptoms are nonspecific. New tools could help in diagnosis and lead to early surgery when needed.
METHODS:: METHODS::A neutropenic patient developed an acute abdomen. CT findings were a diffuse, small-bowel distention with a thickened, distal, ileum wall. Emergency surgery was performed with resection and immediate anastomosis of the distal ileum. Pathology of the small bowel showed a wall necrosis and invasion byAspergillus fumigatus.
RESULTS:: RESULTS::The postoperative course was uneventful except for persisting diarrhea secondary to a coexistent infection withClostridium difficile.Aspergillusantigene in serum was positive, whereas neither pulmonary nor central nervous system aspergillosis was observed on CT scan.
CONCLUSIONS:: CONCLUSIONS::This diagnosis should be considered when neutropenic patients show abdominal pain and distention with fever. Repetition ofAspergillusantigenemia, search for others aspergillosis localizations, CT scan, and colonoscopy with biopsies should be performed until diagnosis allows the administration of early antifungal therapy.
aDepartment of General Surgery, Hôpital de la Pitié, 83 Boulevard de l'Hôpital, 75651, Paris cedex 13, France, e-mail: firstname.lastname@example.org
© The ASCRS 2004