Neutropenic enterocolitis: Difference between revisions

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==Definition==
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==Background==


Necrosis of bowel wall 2/2  microbial invasion
[[File:Diameters of the large intestine.png|thumb|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]
*Also known as "typhlitis"
*Necrosis of bowel wall secondary to polymicrobial invasion
**Involves terminal ileum and colon
**May progress to full-thickness infarction/perforation




==Pathophysiology==
==Clinical Features==


*Typically presents 10-14d after cytotoxic therapy
*[[Special:MyLanguage/neutropenic fever|Fever]]
*[[Special:MyLanguage/RLQ pain|RLQ pain]]
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]]


Usually involves the CECUM


Typically occurs 10-14d after cytotoxic therapy
==Differential Diagnosis==


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{{Oncologic emergencies DDX}}
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{{Abd DDX RLQ}}
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==Si/Sy==


==Evaluation==


Fever


RLQ pain
===Workup<ref>Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.</ref>===


Nausea
*CBC with [[Special:MyLanguage/neutropenia|neutropenia]], [[Special:MyLanguage/thrombocytopenia|thrombocytopenia]]
*Blood cultures positive in ~25-85%, frequently bowel organisms
*CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
*Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis


Vomiting


(mimics appy)
==Management==


*Bowel rest
*[[Special:MyLanguage/NG tube|NG tube]] to suction
*[[Special:MyLanguage/IVF|IVF]]
*TPN
*Consider G-CSF, particularly neutropenia < 100/ml and severe disease<ref>Greil R, Psenak O, Roila F. ESMO Guidelines Working Group. Hematopoietic growth factors: ESMO recommendations for the applications. Ann Oncol. 2008;19(suppl 2:ii):116–1118.</ref>
*Broad spectrum antimicrobials, in particular against gut microbiota to include<ref>Gorschluter M, Mey U, Strehl J, Zinske C, Schepke M, Schmid F, Wolf IG, Sauerbruch T, Glasmacher A, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13.</ref>:
**[[Special:MyLanguage/Metronidazole|Metronidazole]] plus [[Special:MyLanguage/cefepime|cefepime]]
**[[Special:MyLanguage/Piperacillin-tazobactam|Piperacillin-tazobactam]]
**[[Special:MyLanguage/Amphotericin B|Amphotericin B]] when patient remains febrile, neutropenic for greater than 5 days despite broad spectrum antibiotics
*Surgical consult (possible need for right hemicolectomy)<ref>Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.</ref>


==W/U==
CT A/P: cecal distention and wall thickening
==Treatment==
Bowel rest
NG suction
IVF
Broad spec abx


==Disposition==
==Disposition==


*Admit


Surgical consultation (right hemicolectomy)
==Prognosis==


==See Also==


Mortality 50%
*[[Special:MyLanguage/Neutropenic fever|Neutropenic fever]]




==References==


<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:ID]]
[[category:Surgery]]
[[Category:Heme/Onc]]
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Latest revision as of 23:48, 4 January 2026


Background

Average inner diameters and ranges of different sections of the large intestine.[1]
  • Also known as "typhlitis"
  • Necrosis of bowel wall secondary to polymicrobial invasion
    • Involves terminal ileum and colon
    • May progress to full-thickness infarction/perforation


Clinical Features


Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

RLQ Pain


Evaluation

Workup[2]

  • CBC with neutropenia, thrombocytopenia
  • Blood cultures positive in ~25-85%, frequently bowel organisms
  • CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
  • Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis


Management

  • Bowel rest
  • NG tube to suction
  • IVF
  • TPN
  • Consider G-CSF, particularly neutropenia < 100/ml and severe disease[3]
  • Broad spectrum antimicrobials, in particular against gut microbiota to include[4]:
  • Surgical consult (possible need for right hemicolectomy)[5]


Disposition

  • Admit


See Also


References

  1. ↑ Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.
  2. ↑ Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.
  3. ↑ Greil R, Psenak O, Roila F. ESMO Guidelines Working Group. Hematopoietic growth factors: ESMO recommendations for the applications. Ann Oncol. 2008;19(suppl 2:ii):116–1118.
  4. ↑ Gorschluter M, Mey U, Strehl J, Zinske C, Schepke M, Schmid F, Wolf IG, Sauerbruch T, Glasmacher A, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13.
  5. ↑ Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.
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