II. Epidemiology

  1. Rare, but catastrophic cause of Acute Abdominal Pain in patients on Chemotherapy

III. Pathophysiology

  1. Results from Chemotherapy-induced GI mucosa toxicity (and Neutropenia) with subsequent superinfection
  2. Necrotizing colitis involving cecum (but can also affect Large Bowel and proximal Small Bowel)
  3. Similar process as with Necrotizing Enterocolitis in newborns

IV. Risk Factors

  1. HIV Infection
  2. Aplastic Anemia
  3. Immunosuppression
  4. Hematologic Malignancy (more than with solid tumors)

VI. Signs

  1. Typical presentation is with a toxic or septic, ill appearing patient
  2. Abdominal distention

VII. Differential Diagnosis

VIII. Imaging

  1. Abdominal CT
    1. Bowel wall thickening and intramural edema (infarcted bowel)
  2. Avoid tests which risk colon perforation
    1. Barium Enema
    2. Endoscopy

IX. Management

  1. Emergency Surgical Consultation for perforation
    1. Surgical management is based on size of infarcted bowel
  2. Supportive care
  3. Bowel rest
    1. Consider Total Parenteral Nutrition
  4. Broad spectrum IV antibiotics (to cover Gram Negative and Anaerobic Bacteria)
    1. First-Line Agents
      1. Piperacillin-Tazobactam (Zosyn) 4.5 g IV every 6 hours OR
      2. Imipenem-Cilastin 500 mg IV every 6 hours OR
      3. Meropenem 2 g IV every 8 hours
    2. Alternative Agents
      1. Cefepime 2 g IV every 8 hours AND
      2. Metronidazole 500 mg IV every 8 hours
    3. Additional agents to consider in refractory cases
      1. Candida coverage (e.g. echinocandin)
      2. Clostridium difficile coverage (test in all cases)

X. Prognosis

  1. High mortality

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Typhlitis (C0267537)

Definition (MSHCZE) Zánět slepého střeva. Termín t. neoznačuje appendicitidu, v praxi ji však větš. provází a její příznaky jsou velmi podobné. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) Inflammation of the cecum, usually accompanied by neutropenia.(NICHD)
Definition (NCI_CTCAE) A disorder characterized by inflammation of the cecum.
Definition (MSH) Necrotizing inflammation of the CECUM ("typhlon" in Greek), sometimes spreading to the APPENDIX and/or the ILEUM. Symptoms include ABDOMINAL PAIN and DIARRHEA. Its pathogenesis is multifactorial. Typhlitis is often associated with NEUTROPENIA and chemotherapy in immunocompromised individuals (IMMUNOCOMPROMISED HOST).
Concepts Disease or Syndrome (T047)
MSH D053706
SnomedCT 61564002
English Cecitis, cecitis (diagnosis), cecitis, Typhlitis [Disease/Finding], caecitis, cecity, typhlitis, cecal inflammation, Cecum inflamed, Cecal inflammation, Caecal inflammation, Neutropenic Colitis, Caecitis, Typhlitis (disorder), Cecitis, NOS, Typhlitis, NOS, Typhlitis
Portuguese Tiflite, Cecite, Inflamação do cego
Spanish Tiflitis, Cecitis, Inflamación cecal, Inflamación de ciego, cecitis, tiflitis (trastorno), tiflitis
Russian ВОСПАЛЕНИЕ СЛЕПОЙ КИШКИ, СЛЕПОЙ КИШКИ ВОСПАЛЕНИЕ, ТИФЛИТ, СЕГМЕНТАРНЫЙ КОЛИТ, TIFLIT, SEGMENTARNYI KOLIT, SLEPOI KISHKI VOSPALENIE, VOSPALENIE SLEPOI KISHKI
Italian Tiflite, Infiammazione del cieco
German Typhlitis, Zäkumentzündung, Zaekumentzuendung, Entzuendung des Zaekums
French Typhlite, Caecite, Inflammation du caecum, Inflammation caecale
Finnish Umpisuolitulehdus
Czech tyflitida, typhlitis, Zánět céka, Typhlitis
Swedish Tyflit
Polish Zapalenie kątnicy
Japanese 盲腸炎, 盲腸炎-好中球性, 好中球性盲腸炎, モウチョウエン, 盲腸炎症, モウチョウエンショウ
Norwegian Tyflitt
Dutch typhlitis, caecitis, caecale ontsteking, blindedarmontsteking, cecitis
Hungarian Vakbélgyulladás, Typhlitis, Coecum gyulladás

Ontology: Enterocolitis, Neutropenic (C0343387)

Definition (MSH) A syndrome characterized by inflammation in the ILEUM, the CECUM, and the ASCENDING COLON. It is observed in cancer patients with CHEMOTHERAPY-induced NEUTROPENIA or in other immunocompromised individuals (IMMUNOCOMPROMISED HOST).
Concepts Disease or Syndrome (T047)
MSH D044504
SnomedCT 240358005
English Neutropenic enterocolitis, Enterocolitis, Neutropenic [Disease/Finding], Enterocolitis, Neutropenic, Ileocecal Syndrome, Neutropenic Enterocolitis, Syndrome, Ileocecal, Neutropaenic enterocolitis, Neutropaenic enterocolitis (disorder)
Dutch neutropenische enterocolitis, Enterocolitis, neutropene
German neutropene Enterokolitis, Enterokolitis, neutropenische, Neutropenische Enterokolitis
Italian Enterocolite neutropenica, Sindrome ileocecale, Enterocolite da neutropenia
Portuguese Enterocolite neutropénica, Enterocolite Neutropênica
Spanish Enterocolitis neutropénica, enterocolitis neutropénica (trastorno), enterocolitis neutropénica, Enterocolitis Neutropénica
French Syndrome iléocaecal, Syndrome iléo-caecal, Entérocolite du neutropénique, Entérocolite du patient neutropénique, Typhlite du patient neutropénique, Entéro-colite du neutropénique, Entérocolite neutropénique
Swedish Enterokolit, neutrogen
Japanese コウチュウキュウゲンショウセイチョウエン, 回盲部症候群, 好中球減少性腸炎, 腸炎-好中球減少性
Czech enterokolitida neutropenická, Neutropenická enterokolitida
Finnish Neutropeeninen suolitulehdus
Russian ENTEROKOLIT NEITROPENICHESKII, ЭНТЕРОКОЛИТ НЕЙТРОПЕНИЧЕСКИЙ
Polish Zapalenie jelit neutropeniczne
Hungarian Neutropeniás enterocolitis
Norwegian Ileocøkalt syndrom, Nøytropen enterokolitt

Ontology: Neutropenic colitis (C0400823)

Concepts Disease or Syndrome (T047)
SnomedCT 235755005
Italian Colite neutropenica
Japanese 好中球減少性大腸炎, コウチュウキュウゲンショウセイダイチョウエン
Czech Neutropenická kolitida
English colitis neutropenic, neutropenic colitis, Neutropenic colitis, Neutropenic colitis (disorder)
Hungarian Neutropeniás colitis
Spanish colitis neutropénica (trastorno), colitis neutropénica, Colitis neutropénica
Portuguese Colite neutropénica
Dutch neutropene colitis
French Colite neutropénique
German neutropene Kolitis