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Neutropenic Enterocolitis (Typhlitis)


KEY FACTS

Terminology

  • Life-threatening, necrotizing enterocolitis occurring primarily in severely neutropenic patients

Imaging

  • Best imaging tool: CECT with multiplanar reformations

    • Massive mural thickening of cecal ± ascending colon wall

      • –

        Other segments of colon and small bowel can be affected

    • Mucosal hyperenhancement and submucosal edema (marked)

    • Infiltration of pericolonic fat

  • Less common, more severe findings

    • Pneumatosis, extraluminal gas and fluid (perforation)

Top Differential Diagnoses

  • Pseudomembranous colitis

  • Cecal diverticulitis

  • Crohn's colitis

  • Graft-vs.-host disease

Pathology

  • Severely neutropenic patients

  • Majority of cases are those with leukemia &/or hematopoietic stem cell transplant recipients

  • Pathogenesis: Probably due to combination of factors

    • Mucosal injury by cytotoxic drugs

    • Profound immunosuppression

    • Invasion of bowel wall by microorganisms (polymicrobial)

    • Progressive necrosis of bowel wall

Clinical Issues

  • Fever, RLQ tenderness in immunosuppressed patient

  • Watery diarrhea ± hematochezia

Diagnostic Checklist

  • Consider history of chemotherapy for leukemia or bone marrow transplantation

This 25-year-old woman was receiving chemotherapy for synovial sarcoma and became severely neutropenic with complaints of abdominal pain, fever, and diarrhea. Axial CECT shows marked submucosal edema of the cecum and ascending colon
.

Another CECT section in the same patient shows mucosal hyperenhancement
and submucosal edema
.

Coronal reformatted CECT in the same patient shows inflammation of the ascending colon
and terminal ileum
along with pericolonic ascites
.

Another coronal CECT section in the same patient shows pneumatosis
within the colonic wall, which, along with ascites
, suggests perforation, subsequently proven at surgery. Necrotizing, neutropenic colitis was the diagnosis.

TERMINOLOGY

Synonyms

  • Neutropenic enterocolitis, ileocecal syndrome

Definitions

  • Life-threatening, necrotizing enterocolitis occurring primarily in severely neutropenic patients

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