UMEM Educational Pearls

Title: Typhlitis

Keywords: neutropenia, sepsis, abdominal pain, necrotizing enterocolitis (PubMed Search)

Posted: 5/23/2011 by Haney Mallemat, MD (Emailed: 5/24/2011) (Updated: 5/24/2011)
Click here to contact Haney Mallemat, MD

Necrotizing enterocolitis with predilection for cecum.
Occurs in the immunosuppressed, especially when neutropenic (<500 PMNs)
Typically a polymicrobial infection; gram positive cocci, gram negative rods, anaerobes, and/or fungal.
Classically, right lower quadrant pain but can present with diffuse abdominal pain and peritoneal signs.
CT scan with IV and PO contrast is diagnostic (see below)
Treatment:
- Culture and begin broad spectrum antibiotics (cover anaerobes) and antifungals (if suspected)
- Aggressive resuscitation
- Surgical consult for GI perforation or clinical deterioration
High mortality (40-50%)

TIP: Suspect when abdominal pain presents 10-14 after chemotherapy (when PMNs are lowest).

References

Blijlevens NM, et al. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 2000 Jun;25(12):1269-78

http://emedicine.medscape.com/article/375779-overview