Advertisements
//
you're reading...
GI

Neutropenic Colitis (Typhlitis)

History: 50 year old female with right lower quadrant pain.

Perforated typhlitis - axial contrast enhanced CT of the abdomen and pelvis demonstrates marked cecal wall thickening (yellow arrows), a focal defect in the wall of the cecum (red arrow) with extraluminal gas and liquid.

Perforated typhlitis – axial contrast enhanced CT of the abdomen and pelvis demonstrates marked cecal wall thickening (yellow arrows), a focal defect in the wall of the cecum (red arrow) with extraluminal gas and fluid.

Perforated typhlitis - Coronal contrast enhanced CT of the abdomen and pelvis demonstrates marked cecal wall thickening (yellow arrows) and a focal defect in the wall of the cecum (red arrow) as well as extraluminal gas and fluid.

Perforated typhlitis – Coronal contrast enhanced CT of the abdomen and pelvis demonstrates marked cecal wall thickening (yellow arrows) and a focal defect in the wall of the cecum (red arrow) as well as extraluminal gas and fluid.

Typhlitis is a necrotizing process of the cecum, occurring in neutropenic patients who are usually receiving combined chemotherapy. The atonic cecum is affected because of its poor arterial perfusion, the presence of colonic bacteria, and the milieu of immunosuppression.

Other terms that have been used to describe this syndrome include “necrotizing enterocolitis” and “ileocecal syndrome.” Neutropenic enterocolitis occurs most commonly in individuals with hematologic malignancies who are neutropenic and have breakdown of gut mucosal integrity as a result of cytotoxic chemotherapy.

Gross and histologic examinations may reveal bowel wall thickening, discrete or confluent ulcers, mucosal loss, intramural edema, hemorrhage, and necrosis. Various bacterial and/or fungal organisms are often seen infiltrating the bowel wall.

Computed tomography (CT) is the preferred imaging modality for diagnosis. Both oral and intravenous (IV) contrast should be given, when feasible. However, oral contrast is sometimes not tolerated in patients with severe gastrointestinal tract symptoms, and IV contrast is typically avoided in patients with renal insufficiency.

Surgical intervention is recommended for those with perforation with free air in the peritoneum, persistent gastrointestinal bleeding despite correction of coagulopathy and cytopenias, clinical deterioration during close observation and serial examinations, or development of another indication for surgery (eg, appendicitis)

Reference:

Ikard RW. Neutropenic Typhlitis in Adults. Arch Surg. 1981 Jul;116(7):943-5.
Advertisements

About radiologypics

I am a radiology physician from California, USA.

Discussion

No comments yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: