Neutropenic enterocolitis (typhlitis)

Background

• Necrosis of bowel wall 2/2 polymicrobial invasion
  • Involves terminal ileum and colon
  • May progress to full-thickness infarction/perforation
• Occurs 10-14d after cytotoxic therapy

Clinical Presentation

• 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

• Neutropenic fever
  • Neutropenic enterocolitis (typhlitis)
• Leukostasis and hyperleukocytosis
• Hyperviscosity syndrome
• Thromboembolism

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

Diagnosis

Workup

CT A/P: cecal distention and wall thickening

Treatment

1. Bowel rest
2. NG suction
3. IVF
4. Broad spec abx

Disposition

• Surgial consult (poss right hemicolectomy)