View source for Neutropenic enterocolitis (typhlitis)

==Background==
*Necrosis of bowel wall secondary to polymicrobial invasion
**Involves terminal ileum and colon
**May progress to full-thickness infarction/perforation

==Clinical Features==
*Typically presents 10-14d after cytotoxic therapy
*[[neutropenic fever|Fever]]
*[[RLQ pain]]
*[[Nausea/vomiting]]

==Differential Diagnosis==
{{Oncologic emergencies DDX}}
{{Abd DDX RLQ}}

==Evaluation==
===Workup<ref>Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.</ref>===
*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<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>:
**[[Metronidazole]] plus [[cefepime]]
**[[Piperacillin-tazobactam]]
**[[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>

==Disposition==
*Admit

==See Also==
*[[Neutropenic fever]]

==References==
<references/>

[[Category:GI]]
[[Category:ID]]
[[category:Surgery]]
[[Category:Heme/Onc]]