Neutropenic Enterocolitis aka typhlitis, necrotizing enterocolitis, ileocecal syndrome

Definition:

• intestinal mucosal wall edema and disruption of wall integrity in a neutropenic patient 

Pathogenesis:

• Weakened immune system --> intestinal overgrowth --> invasion of opportunistic bacteria.
• May lead to sepsis and bowel perforation.
• Mortality  22%-50%.

Patient population:

• Most commonly seen in patients with hematologic malignancy receiving chemotherapeutic agents   Symptoms: 

• abdominal pain, fever (92%) and diarrhea. Pain is often diffuse.
• may be isolated to  RLQ (ileocecal area). 

Management:

• aggressive IV fluids, correct electrolyte imbalances, bowel rest
• broad spectrum antibiotics (ex. Cefepime and flagyl)
• surgical consultl (9% require surgery).

References:

Lebon, D. et al. Gastrointestinal emergencies in critically ill cancer patients. J Crit Care. 2017; 40:69-75

Nesher, L, Rolston, KV. Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy. Clin Infect Dis. 2013; 56(5):711-7

Rodriguez, FG, et al. Neutropenic Colitis. World J Gastroenterol. 2017; 23(1); 42-47