Neutropenic enterocolitis

Background

Inflammation of right-sided colon in the context of febrile neutropenia
Also known as typhlitis, ileocecal syndrome, cecitis, and previously necrotizing enterocolitis (though the latter more commonly refers to a specific, unrelated syndrome in newborns and should be avoided)

Fever, abdominal pain, diarrhea, and right lower quadrant tenderness with or without peritonitis in the context of febrile neutropenia
- May mimic appendicitis
Can have nausea and vomiting
Abdominal pain can be diffuse
May have melena or hematochezia
Mortality of up to 20%

Abdominal x-ray may show dilated atonic cecum with liquid or gas in the ascending colon, intramural gas, and small bowel dilatation
- However, plain films are often nonspecific and have low sensitivity and specificity
CT is the imaging of choice
- Most frequency and most severely affects the cecum, ascending colon, and terminal ileum
- Findings may include inflammation at the cecum with thickening, fat stranding, pneumatosis intestinalis, bowel wall thickening, and ileus
  - Bowel wall thickening >4 mm is an important finding
  - Inflammation can involve other
- May have small bowel obstruction
- May have intramural hemorrhage or edema
Colonoscopy is relatively contraindicated

Bowel rest with TPN
Broad-spectrum antibiotics
Consider empiric ganciclovir and oral vancomycin with IV metronidazole, wile awaiting CMV and Clostridioides difficile results