Neutropenic enterocolitis (typhlitis)

Background

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

Clinical Features

  • Fever
  • RLQ pain
  • Nausea
  • Vomiting

Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

RLQ Pain

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]:
  • Surgical consult (possible need for right hemicolectomy)[4]

Disposition

  • Admit

See Also

References

  1. Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.
  2. 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.
  3. 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.
  4. Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.