About the journal

Cobiss

Srpski arhiv za celokupno lekarstvo 2017 Volume 145, Issue 1-2, Pages: 81-84
https://doi.org/10.2298/SARH160211017M
Full text ( 1031 KB)


Spontaneous perforation of sigmoid colon in a child with acute lymphoblastic leukemia

Miolski Jelena (University Children's Hospital, Department of Hematology and Oncology, Belgrade + General Hospital “Stefan Visoki”, Department of Pediatrics, Smederevska Palanka)
Lazić Jelena ORCID iD icon (University Childrens Hospital, Department of Hematology and Oncology, Belgrade + School of Medicine, Belgrade)
Radulović Spasoje (University Children's Hospital, Department of Abdominal Surgery, Belgrade)
Petrović Mina (University Children's Hospital, Department of Hematology and Oncology, Belgrade)
Bogićević Vesna (Clinical Center Niš, Clinic for Internal Medicine, Niš)
Janković Srđa (University Children's Hospital, Department of Hematology and Oncology, Belgrade)
Janić Dragana (University Children's Hospital, Department of Hematology and Oncology, Belgrade + School of Medicine, Belgrade)

Introduction. Perforation of the sigmoid colon is rare in children and its descriptions in medical literature are infrequent. Case Outline. In a 13-year-old boy with acute lymphoblastic leukemia, a ten-month course of chemotherapy was accompanied by many complications: parasitic infestation (Enterobius vermicularis), lung candidiasis, esophageal candidiasis, steroid diabetes, anaphylactoid reaction to L-asparaginase, febrile neutropenia, mucositis, anemia, thrombocytopenia, enterocolitis, and respiratory distress syndrome. During reinduction treatment, consisting of dexamethasone, vincristine, doxorubicin, and crisantaspase, he complained of abdominal pain and, upon radiographic examination, was found to have pneumoperitoneum. Because of suspicion of abdominal hollow organ perforation, he was subjected to explorative laparotomy, which yielded the diagnosis of perforation of the sigmoid colon. Conclusion. After an extensive review of the published reports on sigmoid perforation, all associated conditions that could possibly induce perforation – such as Hirschsprung’s disease or foreign body – were systematically excluded in our patient. Although typhlitis was the first diagnostic hypothesis, this was excluded by intraoperative findings, histopathology, and perforation site. To the best of our knowledge, this is the first report of a spontaneous perforation of the sigmoid colon in a child with acute lymphoblastic leukemia.

Keywords: sigmoid perforation, children, immunosuppression, chemotherapy