The classic triad of abdominal pain, fever, and neutropenia. Neutropenic enterocolitis ne is a deadly ileocecalbased disease seen in patients with a recent history of chemotherapy. Jun 22, 2016 neutropenic enterocolitis, also known as typhlitis, agranulocytic colitis, neutropenic enteropathy, and ileocecal syndrome, traditionally affects children treated for leukemia and other conditions. The recommendations on assessment of suspected neutropenic sepsis are based on the national institute for health and care excellence nice clinical guideline sepsis.
Features are those of ileitis consistent with neutropenic enterocolitis and associated with mild small bowel dilation and ascites. Neutropenic enterocolitis goes by numerous synonyms, including hemorrhagic necrosis of the gi tract, necrotizing enterocolitis, agranulocytic colitis, typhlitis, and the ileocecal syndrome. Ultrasonography allows followup imaging without repeated exposure to ionizing radiation, which is especially important in children. Radiographic imaging can also show pneumoperitoneum in patients with suspected bowel perforation37. Typhlitis, also called cecitis or neutropenic colitis, is a necrotizing inflammatory condition which typically involves the cecum and, sometimes, can extend into the. Ed presentation of neutropenic enterocolitis in adult. Neutropenic enterocolitis also referred to as typhlitis or necrotizing enteropathy is a clinical syndrome that involves the gi tract of cancer patients receiving chemotherapy. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and hypertension, neurology, obstetrics, gynecology, and women.
The liver, spleen, pancreas, kidneys and adrenal glands are unremarkable. Neutropenic enterocolitis ne is a lifethreatening infection of the. Jun 10, 2019 neutropenic enterocolitis, also known as typhlitis from greek typhlon blind, referring to the cecum, is an acute lifethreatening condition classically characterized by transmural inflammation of the cecum, often with involvement of the ascending colon and ileum, in patients who are severely myelosuppressed. Neutropenic enterocolitis of typhlitis from the greek word typhlon, meaning cecum is a clinical syndrome that occurs in the setting of disease at chemotherapyinduced neutropenia. Bowel wall thickening has been indicated to be specific for. Neutropenic enterocolitis was defined by the presence of an absolute neutrophil count imaging or mucosal injury on colon biopsy.
The disease is characterized by an inflammatory process involving colon andor small bowel, and it can result in ischemia, necrosis, bacteremia, hemorrhage, and. Terminal ileum and ascending colon may also be affected. Differentials would include those of terminal ileitis, including typhilitis neutropaenic enterocolitis, which is the most likely diagnosis. Neutropenic enterocolitis is a predominantly cecumbased disease with high mortality seen in patients post chemotherapy.
Typhlitis in acute childhood leukemia fulltext medical. Pathogenesis the exact pathogenesis of ne is not completely understood. Pdf neutropenic enterocolitis, a growing concern in the era. Features are those of inflammatory changes involving the distal ileum associated with ileus and ascites. Recently, a larger number of reports have been published of individuals presenting with this syndrome after being treated with newer chemotherapeutic agents for solid. Painless neutropenic enterocolitis in a patient undergoing. Apr 19, 2018 the prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis. Patients who had been diagnosed between 2010 and 2018 were included.
Neutropenic enterocolitis typhlitis neutropenic enterocolitis, also known as typhlitis, agranulocytic colitis, neutropenic enteropathy, and ileocecal syndrome, traditionally affects children treated for leukemia and other conditions. Neutropenic enterocolitis and graft versus host disease. Typhlitis in childhood cancer request pdf researchgate. What is neutropenic enterocolitis or typhlitiscauses. Neutropenic enterocolitis ne is a lifethreatening infection of the immunocompromised. Neutropenic enterocolitis nec is a life threatening complication of. However, during the course of past 3 decades, this condition has been increasingly found in adults who are suffering from different types of solid malignant tumors, myeloproliferative disorders and along with bone marrow and solid organ transplantation due. This article is from indian journal of medical and paediatric oncology. Cecal distension and circumferential thickening of cecal wall. However, controversies still exist about the specificity of certain findings.
In 1960, bierman and amronin first coined the term ileocecal syndrome to describe inflammation. Aug 01, 2007 t o the e ditor neutropenic enterocolitis is a lifethreatening complication in hematological patients, with an associated mortality rate of 29. All statistical analyses were carried out using software spss, version 10. Neutropenic enterocolitis, also known as typhlitis from greek typhlon blind, referring to the cecum, is an acute lifethreatening condition classically characterized by transmural inflammation of the cecum, often with involvement of the ascending colon and ileum, in patients who are severely myelosuppressed. It may complicate chemotherapy for solid tumors 377. Neutropenic enterocolitis ne is a deadly ileocecalbased disease seen in. Neutropenic enterocolitis is a lifethreatening, necrotizing enterocolitis occurring primarily in neutropenic patients. A diagnosis is suspected when a patient develops fever and abdominal pain with severe neutropenia.
Suspect in patient with severe neutropenia absolute neutrophil count imaging findings. The management of neutropenic enterocolitis is controversial. The intestinal tract is a common site of infection in patients with cancer, especially during episodes of neutropenia. Neutropenic enterocolitis may be seen in patients with solid tumors, aplastic anemia and. Pdf neutropenic enterocolitis, a growing concern in the.
Neutropenic enterocolitis is a lethal condition requiring prompt diagnosis. The aetiology and pathogenesis of necrotizing enterocolitis are not definitively understood. An acute lifethreatening condition characterized by transmural inflammation of the caecum, often with involvement of the ascending colon and ileum, which is then vulnerable to bacterial intramural invasion. Neither prospective nor highquality retrospective studies concerning medical or surgical therapies are available. Imaging is necessary to rule out other intraabdominal conditions, since neutropenic enterocolitis is usually a diagnosis of exclusion. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. As computed tomography imaging failed to provide a conclusive diagnosis. Neutropenic enterocolitis and graft versus host disease fig. Other terms that have been used to describe this syndrome include necrotizing enterocolitis and ileocecal syndrome. Signs and symptoms of typhlitis may include diarrhea, a distended abdomen.
The main purpose of this report is to focus on the importance of an accurate etiologic diagnosis of gastrointestinal complications during chemotherapy for acute myeloid leukemia, taking into account that a syndrome characterized by bowel wall thickening associated with diarrhea and abdominal pain may have etiologies different from neutropenic enterocolitis ne and in such a case necessitate a. Neutropenic enterocolitis, also known as typhlitis or ileocecal syndrome, is a rare, but important, complication of neutropenia associated with malignancy. It is particularly associated with neutropenia, a low level of neutrophil granulocytes the most common form of white blood cells in the blood. However, the disorder also affects healthier, nonterminal, neutropenic children and adults with. Neutropenic enterocolitis was defined by the presence of an absolute neutrophil count intestinal overgrowth invasion of opportunistic bacteria. Fatal neutropenic enterocolitis during pegylated interferon and ribavirin combination therapy for chronic hepatitis c virus infection.
Learningradiology typhlitis, neutropenic, enterocolitis. Neutropenic enterocolitis, also referred to as typhlitis, is a lifethreatening gastrointestinal complication of chemotherapy, most often associated with leukemia or lymphoma. Ne ubiquitously affects the cecum, often with involvement of the ascending colon and ileum. The stenosis stenose and dilatation of the small bowel dd is also indicated. Neutropenic enterocolitis ne or typhilitis from the greek word typhlon meaning cecum is one of the serious complications of neutropenia characterized by segmental ulceration and inflammation with necrosis of ileum, caecum and ascending colon which may progress to perforation and septicemia14.
All statistical analyses were performed with the spss 11. The main purpose of this report is to focus on the importance of an accurate etiologic diagnosis of gastrointestinal complications during chemotherapy for acute myeloid leukemia, taking into account that a syndrome characterized by bowel wall thickening associated with diarrhea and abdominal pain may have etiologies different from neutropenic enterocolitis ne and in such a case necessitate. Apr 07, 2018 initially neutropenic enterocolitis or typhlitis was described in children who were undergoing treatment for chemotherapy leukemia. Neutropenic enterocolitis or typhlitis is a fatal and acute necrotizing enterocolitis which occurs mainly in neutropenic patients. Polymicrobic infiltrates in the inflamed bowel wall with subsequent necrotizing perforations and systemic dissemination of infectious agents are the terminal events 1,2,34. Bowel wall thickening has been indicated to be specific for neutropenic enterocolitis in some series. Bowelwall thickening has also been associated with the duration of illness and neutropenia in neutropenic enterocolitis. T o the e ditor neutropenic enterocolitis is a lifethreatening complication in hematological patients, with an associated mortality rate of 29. However, during the course of past 3 decades, this condition has been increasingly found in adults who are suffering from different types of solid malignant tumors, myeloproliferative disorders and along with bone marrow and solid organ transplantation due to.
However, the disorder also affects healthier, nonterminal, neutropenic children and adults with solid. What is neutropenic enterocolitis or typhlitis picture. Improved management of neutropenic enterocolitis using. Jul 25, 2009 the classic clinical features include fever and abdominal pain. Neutropenic enterocolitis, an unusual presentation of abdominal infection mostly in patients with leukemia after chemotherapy, was an ominous complication with high mortality rate ranging from 50% to 100%. With the advent of imaging techniques, computed tomography ct and. Other terms that have been used to descr it seems to us that you have your javascript disabled on your browser. A search for the terms neutropenic enterocolitis, neutropenic colitis, typhlitis, ileocecal syndrome, cecitis, and necrotizing enterocolitis was made in pubmed, exclusive to human studies and with no time limits. The diagnosis of ne should always be considered in immunosuppressed patients, particularly those treated with chemotherapy when they present with appropriate symptoms. Current status of laboratory and imaging diagnosis of.
Ultrasonography was a useful imaging modality for children with suspected typhlitis. 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. Ne has evolved from a complication of patients with leukemia516 to a. It may also be useful for followup to assess the decrease in bowel wall thickening. We undertook a multiinstitutional study of ne, and. The diagnosis is supported by the findings of bowel wall thickening on ultrasonography or ct imaging. Mar 29, 2017 neutropenic enterocolitis is a lifethreatening complication of neutropenia. Neutropenic enterocolitis is a life threatening complication occurring most frequently after intensive chemotherapy in acute leukemia and solid tumors. As histology is not included in the current diagnostic criteria, the pathologic features of ne are poorly understood. No cases of painless neutropenic enterocolitis have yet been reported. A clinical case of neutropenic enterocolitis was described in publication by marine auffret, md, and colleagues from the centre hospitalier darmentieres, france j pharma clin 2012. Fatal neutropenic enterocolitis with docetaxel in france. Typhlitis, also called cecitis or neutropenic colitis, is a necrotizing inflammatory condition which typically involves the cecum and, sometimes, can extend into the ascending colon or terminal ileum.
Early diagnosis of neutropenic enterocolitis by ultrasound. Neutropenic enterocolitis, a growing concern in the era of. Jul 25, 2018 necrotizing enterocolitis continues to be a devastating disease process for very low birth weight infants in neonatal intensive care units. Nov 10, 2014 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. Various names have been given to this disease including typhlitis, neutropenic colitis, necrotizing enterocolitis, ileocecal syndrome and cecitis. Neutropenic enterocolitis ne is characterized by fever and abdominal pain in a neutropenic patient. Neutropenic enterocolitis in adult patients with acute leukemia. The classic clinical features include fever and abdominal pain. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. It is most commonly seen in pediatric patients undergoing treatment for leukemia, but it. Several wellrecognized entities cause distinct clinical syndromes in this setting, including cholecystitis, cholangitis, appendicitis, clostridium difficile associated colitis, cytomegalovirus colitis, neutropenic enterocolitis nec and graftversushost disease gvhd 1, 2. Mesenteric fat stranding secondary to inflammation. Two patients, at risk of wall rupture by us imaging confirmed by ct.
Neutropenic enterocolitis an overview sciencedirect topics. Improved management of neutropenic enterocolitis using early. It is most often seen in patients that have received chemotherapy for acute leukemia or solid tumors, but can occur in other types of cases. Neutropenic enterocolitis is a serious, potentially lethal complication of anticancer therapy. Gross and histologic examinations may reveal bowel wall thickening, discrete or confluent ulcers, mucosal loss, intramural edema, hemorrhage, and necrosis.
Diarrhea in neutropenic patients annals of oncology. Neutropenic enterocolitis is a lifethreatening complication of neutropenia. Abdominal ultrasonography is an important diagnostic imaging study for neutropenic enterocolitis and is preferable to contrast enema. The prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis. A key word search of radiology records for acute leukemia and neutropenic enterocolitis or typhilitis identified a total of 20 cases which. The term necrotizing enterocolitis first appeared in the 1950s when schmid and quaiser described infants dying from necrotic lesions of the gastrointestinal tract. Polymicrobic infiltrates in the inflamed bowel wall with subsequent necrotizing perforations and systemic dissemination of infectious agents are the terminal events 1, 2, 34.
Neutropenic enterocolitis is inflammation of the cecum part of the large intestine that may be associated with infection. Review of the literature shows that patients can develop this condition in the absence of fever and, sometimes, neutropenia. Neutropenic enterocolitis is also known as ileocecal syndrome, necrotizing enterocolitis, typhlenteritis and less commonly caecitis orcecitis. Initially neutropenic enterocolitis or typhlitis was described in children who were undergoing treatment for chemotherapy leukemia. Neutropenic enterocolitis ne, commonly referred to as typhlitis, is a necrotizing inflammatory condition of the mucosal barrier of the intestine, often occurring in individuals with febrile neutropenia fn. It can affect the small and large intestines and the cecum, which is a pouch where the small and large intestines meet. Ne was originally described in children with acute leukemia who had undergone induction chemotherapy. Chang, in abeloffs clinical oncology sixth edition, 2020. Necrotizing enterocolitis nec, a condition characterized by intestinal necrosis affecting the ileum, jejunum andor colon, is a leading cause of morbidity and mortality among premature infants.
It is known that necrotizing enterocolitis is secondary to a complex interaction of multiple factors that results in mucosal damage, which leads to intestinal. Chemotherapyassociated neutropenic enterocolitis of the. Neutropenic sepsis is a major cause of death in people with neutropenia, and is a potentially life. Neutropenic enterocolitis md anderson cancer center.
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