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Neutropenic enterocolitis (typhlitis)
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Contents
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
- 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
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
RLQ Pain
- Appendicitis
- Abdominal aortic aneurysm
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Ectopic
- Endometriosis
- Epiploic appendagitis
- Herpes zoster
- Inguinal hernia
- Ischemic colitis
- Meckel's diverticulum
- Mesenteric lymphadenitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Kidney stone
- Neutropenic enterocolitis (typhlitis)
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.
