Typhlitis is an acute, inflammatory disease of the bowel that occurs in neutropenic patients.
Typhlitis presents 10-14 days after treatment with antineoplastic chemotherapy as it manifests in the setting of neutropenia  . The features are fever, nausea, emesis, watery or bloody diarrhea , and right lower quadrant pain. Also, mucositis may precede the gastrointestinal symptoms.
Remarkable findings may include rebound tenderness and abdominal distention.
Entire Body System
Of these, 97 patients had abdominal pain, and 5 had radiologically proven typhlitis. Nonspecific abdominal pain developed on the 12 /- 11th day posttransplant, whereas patients in whom typhlitis developed were diagnosed on day 15.5 /- 7. [ncbi.nlm.nih.gov]
The severity of typhlitis was related to the duration of neutropenia and the presence of fever or abdominal tenderness. [ncbi.nlm.nih.gov]
[…] watery or bloody diarrhea, and abdominal pain, may be localized in right lower quadrant ( Radiographics 2000;20:399 ) May cause perforation and require surgery Severity in childhood cancer is related to duration of neutropenia and presence of fever or abdominal [pathologyoutlines.com]
At that time, physical examination revealed increased bowel sounds and diffuse abdominal tenderness with no guarding or rebound. [nature.com]
Right Lower Quadrant Tenderness
The classic history of periumbilical pain, with anorexia and nausea, followed by localization of pain in the right lower quadrant is more reliable than right lower quadrant pain itself for diagnosis. 2 Findings of fever, right lower quadrant tenderness [accesspediatrics.mhmedical.com]
Typhlitis refers to a clinical syndrome of fever and right lower quadrant tenderness in a neutropenic patient after cytotoxic chemotherapy. [ncbi.nlm.nih.gov]
She had abdominal pain and distension, decreased bowel sounds, guarding, and right lower quadrant tenderness without rebound. [nature.com]
Perforation of Cecum
One patient had sealed perforation in the cecum, 2 had a perforation in cecum, and 1 had multiple perforations in cecum and ascending colon. [atmph.org]
Sonography appears to be a useful tool not only to detect typhlitis in patients with symptoms suggestive of the disease, but also to follow their clinical course. [ncbi.nlm.nih.gov]
The successful outcome suggests that such an approach might improve the usually grim prognosis in patients whose underlying malignancy offers a clear chance for remission. [nebraska.pure.elsevier.com]
Clinical assessment consists of the patient's history, physical exam, and the appropriate tests.
Neutropenia is confirmed through a complete blood cell (CBC) count, which is a critical test. Blood cultures, clostridium difficile toxin studies and stool cultures are also obtained. Additionally, a complete metabolic panel and arterial blood gas (ABG) should be performed to rule out acidosis.
Computed tomography (CT) is the diagnostic technique of choice. This demonstrates critical features such as diffuse mucosal thickening, edematous colon, and bowel inflammation  . Ultrasonography is also used but its results are nonspecific and may display mucosal thickening of the ileum and cecum . Plain abdominal x-rays are not helpful as this modality yields nonspecific findings.
A colonoscopy typically reveals edema, mucosal erythema, and ulcerations . Another procedure, flexible sigmoidoscopy, may be performed to rule out other pathologies. However, these procedures are associated with complications and are therefore relatively contraindicated.
Neutropenic enterocolitis (typhlitis) is an unusual acute complication of neutropenia, most often associated with leukaemia and lymphoma and characterized by segmental caecal and ascending colonic ulceration that may progress to necrosis, perforation, [ncbi.nlm.nih.gov]
ulceration that may progress to necrosis, perforation, and septicaemia. [link.springer.com]
Microscopically, numerous amoebic trophozoites were present in the necrotic debris of the colon ulcers in all cases [Figure 3]. [atmph.org]
ulcerations. 76 Transmural involvement may be present, and there is usually a sparse inflammatory infiltrate, edema (so-called phlegmonous colitis), intramural hemorrhage, necrosis, and evidence of either bacterial or fungal infection. [ncbi.nlm.nih.gov]
Patients with typhlitis are admitted to the intensive care unit (ICU) and managed conservatively with serial abdominal exams, nasogastric suction, administration of intravenous (IV) fluids, and transfusion of blood products as needed. A key component of the therapy is treatment with broad-spectrum antibiotics that include anaerobic coverage  . Also, granulocyte colony-stimulating factor (G-CSF) may be used in patients with significant neutropenia although it has not demonstrated benefit .
Surgery is reserved for patients with persistent GI hemorrhage after correction of neutropenia, intraperitoneal perforation, clinical deterioration indicative of sepsis, and the development of an acute abdominal condition that warrants surgical intervention  .
Early diagnosis and aggressive treatment can improve the outcome , which depends on prompt correction of the white blood cell (WBC) count. The mortality rate is 40% to 50% due to severe complications such as bowel perforation, gastrointestinal (GI) hemorrhage, GI obstruction, abdominal abscess, and sepsis.
Typhlitis is most prevalent in patients with immunocompromised states, especially in those undergoing chemotherapy.
The cecum is susceptible to this condition due to its poor perfusion, microbial colonization, and lymphatic drainage . The ileum and/or ascending colon may also be affected. With regards to the pathophysiology, it is thought that cytotoxic agents cause direct mucosal injury and neutropenia. The latter allows for overgrowth of enteric bacteria, in which endotoxins cause mucosal damage and ischemia .
Antibiotic prophylaxis in neutropenic patients may be helpful.
Typhlitis, also called neutropenic enterocolitis, is a necrotizing disease that affects the cecum and possibly other bowel segments in patients who recently received chemotherapy or those with an immunocompromised condition. This disease should be suspected in patients presenting with neutropenia, fever, and abdominal pain . The diagnosis is achieved through the patient's history, physical exam, and the proper imaging studies. Patients are usually managed conservatively; surgery may occasionally be indicated.
Typhlitis is a condition that develops in patients with weakened immune systems who are receiving chemotherapy for cancer. The symptoms are abdominal pain, fever, nausea, vomiting, diarrhea, etc. It is diagnosed through the history, physical exam, and imaging tests. Patients with this disease are treated with bowel rest, antibiotics, and other conservative measures unless surgery is necessary.
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