Typhlitis

Typhlitis

Typhlitis, also known as neutropenic enterocolitis, is an inflammatory condition of the cecum, which is part of the large intestine. It is most commonly seen in patients who are immunocompromised, particularly those undergoing chemotherapy for cancer. The condition is characterized by inflammation, necrosis, and sometimes perforation of the bowel wall, leading to serious complications if not promptly treated.

Pathophysiology

Typhlitis occurs when the mucosal lining of the cecum becomes inflamed, often due to a combination of factors including:

• Neutropenia: A significant reduction in neutrophils, a type of white blood cell crucial for fighting infections, often due to chemotherapy.
• Mucosal injury: Damage to the intestinal lining, which can be caused by cytotoxic drugs.
• Bacterial invasion: Opportunistic bacteria can invade the damaged mucosa, leading to infection and further inflammation.

The combination of these factors can lead to bowel wall necrosis and, in severe cases, perforation, which can result in peritonitis and sepsis.

Clinical Presentation

Patients with typhlitis typically present with:

• Abdominal pain: Often localized to the right lower quadrant.
• Fever: Due to infection and inflammation.
• Diarrhea: Sometimes bloody, due to mucosal damage.
• Nausea and vomiting: Common gastrointestinal symptoms.

Diagnosis

Diagnosis of typhlitis is primarily clinical, supported by imaging studies such as:

• CT scan: The preferred imaging modality, which may show thickening of the cecal wall, pneumatosis intestinalis, or free air if perforation has occurred.
• Ultrasound: Can be used to assess bowel wall thickening and fluid collections.

Laboratory tests may reveal neutropenia and elevated inflammatory markers.

Treatment

Management of typhlitis involves:

• Supportive care: Including bowel rest, intravenous fluids, and nutritional support.
• Antibiotics: Broad-spectrum antibiotics to cover gram-negative and anaerobic bacteria.
• Surgical intervention: Required in cases of perforation, persistent bleeding, or failure of medical management.

Prognosis

The prognosis of typhlitis depends on the severity of the condition and the promptness of treatment. Early recognition and management are crucial to prevent complications such as bowel perforation and sepsis.

Prevention

Preventive strategies include:

• Prophylactic antibiotics: In high-risk patients to prevent bacterial translocation.
• Careful monitoring: Of neutropenic patients for early signs of gastrointestinal complications.

Also see

• Neutropenia
• Chemotherapy
• Cecum
• Peritonitis
• Sepsis