XXXX : selective surgical management.

@entity1 @entity24386 @entity390 @entity137 @entity295 @entity548 @entity39 @entity1661 @entity344 @entity2592 @entity15856 @entity3052 @entity11563 @entity1398 @entity733 @entity9358
@entity15856 is a @entity24386 of varying severity. Its incidence is increasing, particularly in @entity1 with @entity3052 undergoing high dose @entity2592 chemotherapy. The onset is heralded by prodromal fever, @entity11563 , @entity1661 , and @entity390 during the phase of severe @entity1398 . The symptoms may then localize to the right lower quadrant with an associated increase in systemic @entity137 . The diagnosis can be confirmed in these and other less specific cases by serial reexamination and abdominal radiographs, ultrasonography, computerized tomograms, or radionucleotide scans. The mainstay of management is complete bowel rest with nasogastric suction and total parenteral nutrition. Broad-spectrum combination antibiotics are essential, as is the avoidance of laxatives or antidiarrheal agents. Granulocyte support may be helpful. @entity1 with a history of nonspecific @entity344 or of true @entity15856 , successfully managed nonoperatively, should have prophylactic bowel rest and total parenteral nutrition instituted at the beginning of further chemotherapy. @entity1 with ongoing severe systemic @entity295 who do not respond to chemotherapy and those with overt perforation, obstruction, @entity548 , or @entity733 formation require surgical intervention. All @entity39 material must be resected, usually by a right hemicolectomy, ileostomy, and @entity9358 . Divided ileostomy for less severe cases may be useful. Failure to remove the @entity39 focus in these severely immunocompromised @entity1 is fatal. With adequate recognition of @entity15856 and its precipitating factors, the incidence of complications can be reduced through prevention and timely surgical intervention. Although @entity15856 developed in a quarter of our @entity3052 @entity1 , use of this combined approach was successful in all cases.
