Neutropenic enterocolitis (typhlitis): Difference between revisions
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==Background== | ==Background== | ||
*Necrosis of bowel wall | *Necrosis of bowel wall secondary to polymicrobial invasion | ||
**Involves terminal ileum and colon | **Involves terminal ileum and colon | ||
**May progress to full-thickness infarction/perforation | **May progress to full-thickness infarction/perforation | ||
==Clinical | ==Clinical Features== | ||
*Fever | *Typically presents 10-14d after cytotoxic therapy | ||
*RLQ pain | *[[neutropenic fever|Fever]] | ||
*Nausea | *[[RLQ pain]] | ||
*[[Nausea/vomiting]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Oncologic emergencies DDX}} | {{Oncologic emergencies DDX}} | ||
{{Abd DDX RLQ}} | |||
== | ==Evaluation== | ||
===Workup=== | ===Workup<ref>Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.</ref>=== | ||
CT A/P: cecal distention | *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== | ==Disposition== | ||
* | *Admit | ||
==See Also== | |||
*[[Neutropenic fever]] | |||
==References== | |||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | [[Category:ID]] | ||
[[category:Surgery]] | |||
[[Category:Heme/Onc]] | |||
Latest revision as of 21:51, 29 October 2019
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
- Fever
- RLQ pain
- Nausea/vomiting
Differential Diagnosis
Oncologic Emergencies
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
Evaluation
Workup[1]
- 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[2]
- Broad spectrum antimicrobials, in particular against gut microbiota to include[3]:
- 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)[4]
Disposition
- Admit
See Also
References
- ↑ Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.
- ↑ 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.
- ↑ 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.
- ↑ Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.