Neutropenic enterocolitis

Neutropenic enterocolitis

Classification and external resources
ICD-9-CM	540.0 540.9 541
DiseasesDB	31505
eMedicine	radio/869
MeSH	D020345

Neutropenic enterocolitis, also known as typhlitis or typhlenteritis, and less commonly called caecitis or cecitis, is inflammation of the cecum (part of the large intestine) that may be associated with infection.^[1] It is particularly associated with neutropenia, a low level of neutrophil granulocytes (the most common form of white blood cells) in the blood.

Signs and symptoms

Signs and symptoms of typhlitis may include diarrhea, a distended abdomen, fever, chills, nausea, vomiting, and abdominal pain or tenderness.^[2]

Cause

The condition is usually caused by Gram-positive enteric commensal bacteria of the gut (gut flora). Clostridium difficile is a species of Gram-positive bacteria that commonly causes severe diarrhea and other intestinal diseases when competing bacteria are wiped out by antibiotics, causing pseudomembranous colitis, whereas C. septicum is responsible for most cases of neutropenic enterocolitis.^[3]

Typhlitis most commonly occurs in immunocompromised patients, such as those undergoing chemotherapy,^[4] patients with AIDS, kidney transplant patients, or the elderly.^[2]

Diagnosis

Typhlitis is diagnosed with a radiograph CT scan showing thickening of the cecum and "fat stranding".

Treatment

Typhlitis is a medical emergency. It has a very poor prognosis and is often fatal unless promptly recognized and aggressively treated.^[4]

Successful treatment hinges on:

Early diagnosis provided by a high index of suspicion and the use of CT scanning
Nonoperative treatment for uncomplicated cases
Elective right hemicolectomy to prevent recurrence

"...The authors have found nonoperative treatment highly effective in patients who do not manifest signs of peritonitis, perforation, gastrointestinal hemorrhage, or clinical deterioration. Recurrent typhlitis was frequent after conservative therapy (recurrence rate, 67 percent), however."^[4]

Prognosis

Inflammation can spread to other parts of the gut in patients with typhlitis. The condition can also cause the cecum to become distended and can cut off its blood supply. This and other factors can result in necrosis and perforation of the bowel, which can cause peritonitis and sepsis.^[5]

The mortality rate for typhlitis can be as high as 50%, mostly because it is frequently associated with bowel perforation.^[2]

References

↑ Definition at thefreedictionary.com
1 2 3 Stoer TM, Koslin DB (2004). "Typhlitis Imaging". Medscape. WebMD LLC. Retrieved September 3, 2016.
↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC498711/
1 2 3 Keidan RD, Fanning J, Gatenby RA, Weese JL (Mar 1989). "Recurrent typhlitis. A disease resulting from aggressive chemotherapy". Dis Colon Rectum. 32(3): 206–9. doi:10.1007/BF02554529. PMID 2920627.
↑ Boggio L, Pooley R, Winter JN (February 2000). "Typhlitis complicating autologous blood stem cell transplantation for breast cancer". Nature. Macmillan Publishers Limited. 25 (3): 321–6.

Diseases of the digestive system (primarily K20–K93, 530–579)

Upper GI tract

Esophagus	Esophagitis Candidal Eosinophilic Herpetiform Rupture Boerhaave syndrome Mallory-Weiss syndrome UES Zenker's diverticulum LES Barrett's esophagus Esophageal motility disorder Nutcracker esophagus Achalasia Diffuse esophageal spasm Gastroesophageal reflux disease (GERD) Laryngopharyngeal reflux (LPR) Esophageal stricture Megaesophagus

Stomach	Gastritis Atrophic Ménétrier's disease Gastroenteritis Peptic (gastric) ulcer Cushing ulcer Dieulafoy's lesion Dyspepsia Pyloric stenosis Achlorhydria Gastroparesis Gastroptosis Portal hypertensive gastropathy Gastric antral vascular ectasia Gastric dumping syndrome Gastric volvulus

Lower GI tract:
Intestinal/
Enteropathy

Small intestine (Duodenum/Jejunum/Ileum)	Enteritis Duodenitis Jejunitis Ileitis Peptic (duodenal) ulcer Curling's ulcer Malabsorption: Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption

Large intestine (Appendix/Colon)	Appendicitis Colitis Pseudomembranous Ulcerative Ischemic Microscopic Collagenous Lymphocytic Functional colonic disease IBS Intestinal pseudoobstruction / Ogilvie syndrome Megacolon / Toxic megacolon Diverticulitis/Diverticulosis

Large and/or small	Enterocolitis Necrotizing Gastroenterocolitis IBD Crohn's disease Vascular: Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Ileus Intussusception Volvulus Fecal impaction Constipation Diarrhea Infectious Intestinal adhesions

Rectum	Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus

Anal canal	Anal fissure/Anal fistula Anal abscess Anal dysplasia Pruritus ani

GI bleeding/BIS

Accessory

Liver	Hepatitis Viral hepatitis Autoimmune hepatitis Alcoholic hepatitis Cirrhosis PBC Fatty liver NASH Vascular Budd-Chiari syndrome Hepatic veno-occlusive disease Portal hypertension Nutmeg liver Alcoholic liver disease Liver failure Hepatic encephalopathy Acute liver failure Liver abscess Pyogenic Amoebic Hepatorenal syndrome Peliosis hepatis Metabolic disorders Wilson's disease Hemochromatosis

Gallbladder	Cholecystitis Gallstones/Cholecystolithiasis Cholesterolosis Rokitansky-Aschoff sinuses Postcholecystectomy syndrome Porcelain gallbladder

Bile duct/ Other biliary tree	Cholangitis Primary sclerosing cholangitis Secondary sclerosing cholangitis Ascending Cholestasis/Mirizzi's syndrome Biliary fistula Haemobilia Gallstones/Cholelithiasis Common bile duct Choledocholithiasis Biliary dyskinesia Sphincter of Oddi dysfunction

Pancreatic	Pancreatitis Acute Chronic Hereditary Pancreatic abscess Pancreatic pseudocyst Exocrine pancreatic insufficiency Pancreatic fistula

Abdominopelvic

Hernia	Diaphragmatic Congenital Hiatus Inguinal Indirect Direct Umbilical Femoral Obturator Spigelian Lumbar Petit's Grynfeltt-Lesshaft Undefined location Incisional Internal hernia Richter's

Peritoneal	Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum

Inflammation

Acute

Plasma derived mediators

Cell derived mediators

preformed:	Lysosome granules biogenic amines Histamine Serotonin

synthesized on demand:	cytokines IFN-γ IL-8 TNF-α IL-1 eicosanoids Leukotriene B4 Prostaglandins Nitric oxide Kinins

Chronic

Processes

Traditional:	Rubor Calor Tumor Dolor Functio laesa

Modern:	Acute-phase reaction/Fever Vasodilation Increased vascular permeability Exudate Leukocyte extravasation Chemotaxis

Specific locations

mouth	Stomatitis Gingivitis Gingivostomatitis Glossitis Tonsillitis Sialadenitis/Parotitis Cheilitis Pulpitis Gnathitis

tract	Esophagitis Gastritis Gastroenteritis Enteritis Colitis Enterocolitis Duodenitis Ileitis Caecitis Appendicitis Proctitis

accessory	Hepatitis Ascending cholangitis Cholecystitis Pancreatitis Peritonitis

Integumentary

Musculoskeletal

Arthritis
Dermatomyositis
soft tissue
Osteochondritis: Osteitis/Osteomyelitis
- Spondylitis
- Periostitis
Chondritis

Urinary

Reproductive

female:	Oophoritis Salpingitis Endometritis Parametritis Cervicitis Vaginitis Vulvitis Mastitis

male:	Orchitis Epididymitis Prostatitis Seminal vesiculitis Balanitis Posthitis Balanoposthitis

pregnancy/newborn:	Chorioamnionitis Funisitis Omphalitis

Endocrine

Lymphatic

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