UMEM Educational Pearls

Category: Critical Care

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).


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