Neutropenic enterocolitis: Difference between revisions
 
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==Definition==
==Background==
Necrosis of bowel wall 2/2  microbial invasion
[[File:Diameters of the large intestine.png|thumb|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]
*Also known as "typhlitis"
*Necrosis of bowel wall secondary to polymicrobial invasion
**Involves terminal ileum and colon
**May progress to full-thickness infarction/perforation


==Pathophysiology==
==Clinical Features==
#Usually involves the CECUM
*Typically presents 10-14d after cytotoxic therapy
#Typically occurs 10-14d after cytotoxic therapy
*[[neutropenic fever|Fever]]
*[[RLQ pain]]
*[[Nausea/vomiting]]


==Diagnosis==
==Differential Diagnosis==
#Fever
{{Oncologic emergencies DDX}}
#RLQ pain
{{Abd DDX RLQ}}
#Nausea
#Vomiting
#(mimics appy)


==Workup==
==Evaluation==
CT A/P: cecal distention and wall thickening
===Workup<ref>Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.</ref>===
*CBC with [[neutropenia]], [[thrombocytopenia]]
*Blood cultures positive in ~25-85%, frequently bowel organisms
*CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
*Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis


==Treatment==
==Management==
#Bowel rest
*Bowel rest
#NG suction
*[[NG tube]] to suction
#IVF
*[[IVF]]
#Broad spec abx
*TPN
*Consider G-CSF, particularly neutropenia < 100/ml and severe disease<ref>Greil R, Psenak O, Roila F. ESMO Guidelines Working Group. Hematopoietic growth factors: ESMO recommendations for the applications. Ann Oncol. 2008;19(suppl 2:ii):116–1118.</ref>
*Broad spectrum antimicrobials, in particular against gut microbiota to include<ref>Gorschluter M, Mey U, Strehl J, Zinske C, Schepke M, Schmid F, Wolf IG, Sauerbruch T, Glasmacher A, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13.</ref>:
**[[Metronidazole]] plus [[cefepime]]
**[[Piperacillin-tazobactam]]
**[[Amphotericin B]] when patient remains febrile, neutropenic for greater than 5 days despite broad spectrum antibiotics
*Surgical consult (possible need for right hemicolectomy)<ref>Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.</ref>


==Disposition==
==Disposition==
Surgical consultation (right hemicolectomy)
*Admit


==Prognosis==
==See Also==
Mortality 50%
*[[Neutropenic fever]]
 
==References==
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:ID]]
[[Category:ID]]
[[category:Surgery]]
[[Category:Heme/Onc]]

Latest revision as of 21:10, 24 September 2025

Background

Average inner diameters and ranges of different sections of the large intestine.[1]
  • Also known as "typhlitis"
  • Necrosis of bowel wall secondary to polymicrobial invasion
    • Involves terminal ileum and colon
    • May progress to full-thickness infarction/perforation

Clinical Features

Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

RLQ Pain

Evaluation

Workup[2]

  • CBC with neutropenia, thrombocytopenia
  • Blood cultures positive in ~25-85%, frequently bowel organisms
  • CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
  • Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis

Management

  • Bowel rest
  • NG tube to suction
  • IVF
  • TPN
  • Consider G-CSF, particularly neutropenia < 100/ml and severe disease[3]
  • Broad spectrum antimicrobials, in particular against gut microbiota to include[4]:
  • Surgical consult (possible need for right hemicolectomy)[5]

Disposition

  • Admit

See Also

References

  1. ↑ Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.
  2. ↑ Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.
  3. ↑ Greil R, Psenak O, Roila F. ESMO Guidelines Working Group. Hematopoietic growth factors: ESMO recommendations for the applications. Ann Oncol. 2008;19(suppl 2:ii):116–1118.
  4. ↑ Gorschluter M, Mey U, Strehl J, Zinske C, Schepke M, Schmid F, Wolf IG, Sauerbruch T, Glasmacher A, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13.
  5. ↑ Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.
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