Neutropenic enterocolitis

Neutropenic enterocolitis
Classification and external resources
ICD-9-CM 540.0 540.9 541
DiseasesDB 31505
eMedicine radio/869
MeSH D020345

Neutropenic enterocolitis, also known as typhlitis or typhlenteritis, and less commonly called caecitis or cecitis, is inflammation of the cecum (part of the large intestine) that may be associated with infection.[1] It is particularly associated with neutropenia, a low level of neutrophil granulocytes (the most common form of white blood cells) in the blood.

Signs and symptoms

Signs and symptoms of typhlitis may include diarrhea, a distended abdomen, fever, chills, nausea, vomiting, and abdominal pain or tenderness.[2]

Cause

The condition is usually caused by Gram-positive enteric commensal bacteria of the gut (gut flora). Clostridium difficile is a species of Gram-positive bacteria that commonly causes severe diarrhea and other intestinal diseases when competing bacteria are wiped out by antibiotics.

Typhlitis most commonly occurs in immunocompromised patients, such as those undergoing chemotherapy,[3] patients with AIDS, kidney transplant patients, or the elderly.[2]

Diagnosis

Typhlitis is diagnosed with a radiograph CT scan showing thickening of the cecum and "fat stranding".

Treatment

Typhlitis is a medical emergency. It has a very poor prognosis and is often fatal unless promptly recognized and aggressively treated.[3]

Successful treatment hinges on:

  1. Early diagnosis provided by a high index of suspicion and the use of CT scanning
  2. Nonoperative treatment for uncomplicated cases
  3. Elective right hemicolectomy to prevent recurrence

"...The authors have found nonoperative treatment highly effective in patients who do not manifest signs of peritonitis, perforation, gastrointestinal hemorrhage, or clinical deterioration. Recurrent typhlitis was frequent after conservative therapy (recurrence rate, 67 percent), however."[3]

Prognosis

Inflammation can spread to other parts of the gut in patients with typhlitis. The condition can also cause the cecum to become distended and can cut off its blood supply. This and other factors can result in necrosis and perforation of the bowel, which can cause peritonitis and sepsis.[4]

The mortality rate for typhlitis can be as high as 50%, mostly because it is frequently associated with bowel perforation.[2]

See also

References

  1. ↑ Definition at thefreedictionary.com
  2. 1 2 3 Stoehr TM and Koslin DB. 2004. Typhlitis Imaging. emedicine.com.
  3. 1 2 3 Keidan, RD; Fanning, Gatenby, Weese (Mar 1989). "Recurrent typhlitis. A disease resulting from aggressive chemotherapy". Dis Colon Rectum. 32(3): 206–9. doi:10.1007/BF02554529. PMID 2920627. Cite uses deprecated parameter |coauthors= (help);
  4. ↑ L Boggio1, R Pooley2, S I Roth2 and J N Winter1 Typhlitis complicating autologous blood stem cell transplantation for breast cancer Nature, February 2000, Volume 25, Number 3, Pages 321-326
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