II. Epidemiology
- Rare, but catastrophic cause of Acute Abdominal Pain in patients on Chemotherapy
III. Pathophysiology
- Results from Chemotherapy-induced GI mucosa toxicity (and Neutropenia) with subsequent superinfection
- Necrotizing colitis involving cecum (but can also affect Large Bowel and proximal Small Bowel)
- Similar process as with Necrotizing Enterocolitis in newborns
IV. Risk Factors
- HIV Infection
- Aplastic Anemia
- Immunosuppression
- Hematologic Malignancy (more than with solid tumors)
V. Symptoms
- Fever
- Right Lower Quadrant Abdominal Pain
- Abdominal cramping
- Diarrhea
- Gastrointestinal Bleeding
VI. Signs
- Typical presentation is with a toxic or septic, ill appearing patient
- Abdominal Distention
VII. Differential Diagnosis
VIII. Imaging
-
Abdominal CT
- Bowel wall thickening and intramural edema (infarcted bowel)
- Avoid tests which risk colon perforation
- Barium Enema
- Endoscopy
IX. Management
- Emergency Surgical Consultation for perforation
- Surgical management is based on size of infarcted bowel
- Supportive care
-
Bowel rest
- Consider Total Parenteral Nutrition
- Broad spectrum IV Antibiotics (to cover Gram Negative and Anaerobic Bacteria)
- First-Line Agents
- Piperacillin-Tazobactam (Zosyn) 4.5 g IV every 6 hours OR
- Imipenem-Cilastin 500 mg IV every 6 hours OR
- Meropenem 2 g IV every 8 hours
- Alternative Agents
- Cefepime 2 g IV every 8 hours AND
- Metronidazole 500 mg IV every 8 hours
- Additional agents to consider in refractory cases
- Candida coverage (e.g. Echinocandin)
- Clostridium difficile coverage (test in all cases)
- First-Line Agents
X. Prognosis
- High mortality
XI. References
- Aurora and Herbert in Majoewsky (2013) EM:Rap 13(10): 1-4
- Cloutier (2010) Hematol Oncol Clin North Am 24(3): 577-84 [PubMed]
- Higdon (2006) Am Fam Physician 74:1873-80 [PubMed]
- Nesher (2013) Clin Infect Dis 56(5):711-7 [PubMed]
- Zuckerman (2012) Blood 120(10): 1993-2002 [PubMed]
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Related Studies
Definition (MSHCZE) | Zánět slepého střeva. Termín t. neoznačuje appendicitidu, v praxi ji však větš. provází a její příznaky jsou velmi podobné. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (NCI) | Inflammation of the cecum, usually accompanied by neutropenia.(NICHD) |
Definition (NCI_CTCAE) | A disorder characterized by inflammation of the cecum. |
Definition (MSH) | Necrotizing inflammation of the CECUM ("typhlon" in Greek), sometimes spreading to the APPENDIX and/or the ILEUM. Symptoms include ABDOMINAL PAIN and DIARRHEA. Its pathogenesis is multifactorial. Typhlitis is often associated with NEUTROPENIA and chemotherapy in immunocompromised individuals (IMMUNOCOMPROMISED HOST). |
Concepts | Disease or Syndrome (T047) |
MSH | D053706 |
SnomedCT | 61564002 |
English | Cecitis, cecitis (diagnosis), cecitis, Typhlitis [Disease/Finding], caecitis, cecity, typhlitis, cecal inflammation, Cecum inflamed, Cecal inflammation, Caecal inflammation, Neutropenic Colitis, Caecitis, Typhlitis (disorder), Cecitis, NOS, Typhlitis, NOS, Typhlitis |
Portuguese | Tiflite, Cecite, Inflamação do cego |
Spanish | Tiflitis, Cecitis, Inflamación cecal, Inflamación de ciego, cecitis, tiflitis (trastorno), tiflitis |
Russian | ВОСПАЛЕНИЕ СЛЕПОЙ КИШКИ, СЛЕПОЙ КИШКИ ВОСПАЛЕНИЕ, ТИФЛИТ, СЕГМЕНТАРНЫЙ КОЛИТ, TIFLIT, SEGMENTARNYI KOLIT, SLEPOI KISHKI VOSPALENIE, VOSPALENIE SLEPOI KISHKI |
Italian | Tiflite, Infiammazione del cieco |
German | Typhlitis, Zäkumentzündung, Zaekumentzuendung, Entzuendung des Zaekums |
French | Typhlite, Caecite, Inflammation du caecum, Inflammation caecale |
Finnish | Umpisuolitulehdus |
Czech | tyflitida, typhlitis, Zánět céka, Typhlitis |
Swedish | Tyflit |
Polish | Zapalenie kątnicy |
Japanese | 盲腸炎, 盲腸炎-好中球性, 好中球性盲腸炎, モウチョウエン, 盲腸炎症, モウチョウエンショウ |
Norwegian | Tyflitt |
Dutch | typhlitis, caecitis, caecale ontsteking, blindedarmontsteking, cecitis |
Hungarian | Vakbélgyulladás, Typhlitis, Coecum gyulladás |
Ontology: Enterocolitis, Neutropenic (C0343387)
Definition (MSH) | A syndrome characterized by inflammation in the ILEUM, the CECUM, and the ASCENDING COLON. It is observed in cancer patients with CHEMOTHERAPY-induced NEUTROPENIA or in other immunocompromised individuals (IMMUNOCOMPROMISED HOST). |
Concepts | Disease or Syndrome (T047) |
MSH | D044504 |
SnomedCT | 240358005 |
English | Neutropenic enterocolitis, Enterocolitis, Neutropenic [Disease/Finding], Enterocolitis, Neutropenic, Ileocecal Syndrome, Neutropenic Enterocolitis, Syndrome, Ileocecal, Neutropaenic enterocolitis, Neutropaenic enterocolitis (disorder) |
Dutch | neutropenische enterocolitis, Enterocolitis, neutropene |
German | neutropene Enterokolitis, Enterokolitis, neutropenische, Neutropenische Enterokolitis |
Italian | Enterocolite neutropenica, Sindrome ileocecale, Enterocolite da neutropenia |
Portuguese | Enterocolite neutropénica, Enterocolite Neutropênica |
Spanish | Enterocolitis neutropénica, enterocolitis neutropénica (trastorno), enterocolitis neutropénica, Enterocolitis Neutropénica |
French | Syndrome iléocaecal, Syndrome iléo-caecal, Entérocolite du neutropénique, Entérocolite du patient neutropénique, Typhlite du patient neutropénique, Entéro-colite du neutropénique, Entérocolite neutropénique |
Swedish | Enterokolit, neutrogen |
Japanese | コウチュウキュウゲンショウセイチョウエン, 回盲部症候群, 好中球減少性腸炎, 腸炎-好中球減少性 |
Czech | enterokolitida neutropenická, Neutropenická enterokolitida |
Finnish | Neutropeeninen suolitulehdus |
Russian | ENTEROKOLIT NEITROPENICHESKII, ЭНТЕРОКОЛИТ НЕЙТРОПЕНИЧЕСКИЙ |
Polish | Zapalenie jelit neutropeniczne |
Hungarian | Neutropeniás enterocolitis |
Norwegian | Ileocøkalt syndrom, Nøytropen enterokolitt |
Ontology: Neutropenic colitis (C0400823)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 235755005 |
Italian | Colite neutropenica |
Japanese | 好中球減少性大腸炎, コウチュウキュウゲンショウセイダイチョウエン |
Czech | Neutropenická kolitida |
English | colitis neutropenic, neutropenic colitis, Neutropenic colitis, Neutropenic colitis (disorder) |
Hungarian | Neutropeniás colitis |
Spanish | colitis neutropénica (trastorno), colitis neutropénica, Colitis neutropénica |
Portuguese | Colite neutropénica |
Dutch | neutropene colitis |
French | Colite neutropénique |
German | neutropene Kolitis |