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)
Microbiology
Pathophysiology
Clinical Manifestations
Fever, abdominal pain, diarrhea, and right lower quadrant tenderness with or without peritonitis in the context of febrile neutropenia
Can have nausea and vomiting
Abdominal pain can be diffuse
May have melena or hematochezia
Mortality of up to 20%
Differential Diagnosis
Investigations
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
Management
Further Reading
