Fact-sheet: Typhlitis
Updated on 04/17/2018 at 5:07 PM
View all RADEOS cases associated with this fact-sheet
Definition
Neutropenic colitis:
- is also known as typhlitis.
- is an inflammatory process related to infection by intestinal organisms that become pathogenic, CMV, clostridium, fungal infection.
- is secondary to mucosal injury resulting from cytotoxic treatments and decreased immune defenses.
- is among the main causes of acute abdomen in immunocompromised patients.
- occurs in a context of immunosuppression: leukemia, HIV, transplantation, chemotherapy (typically 10 to 14 days after the start of cytotoxic chemotherapy).
Clinical features
Right iliac fossa pain in a neutropenic patient.
Possible palpable mass in the right iliac fossa.
Fever.
Often watery diarrhea.
Radiography
Plain abdominal radiograph:
- Nonspecific.
- Right iliac fossa opacity.
- Localized intramural pneumatosis.
- Thumbprinting of the cecal walls.
Ultrasound
Nonspecific.
- Cecal wall thickening.
- Intra-abdominal fluid collection.
CT
Performed after contrast administration during the portal venous phase.
- Circumferential thickening of the cecal wall, correlated with prognosis (60% mortality if > 1 cm; 4.2% if less). Cecal involvement that may extend to the right colon or the terminal ileum.
- Narrowing of the cecal lumen.
- Submucosal edema with accordion sign when marked.
- Accordion sign: irregular polypoid wall thickening.
- Intramural pneumatosis in 20% of cases: poor prognosis.
- Pericolonic fat stranding.
Complications: abscess, transmural bowel necrosis, acute perforation and peritonitis, portal venous gas.
Differential diagnosis
Acute appendicitis.
Pseudomembranous colitis due to Clostridium difficile, but typically involves the entire colon.
CMV colitis, but with deeper ulcerations.
Graft-versus-host disease, but a different clinical context: typically occurs 100 days after allogeneic transplantation.