Overview
Neutropenic typhlitis, also known as neutropenic enterocolitis, is a severe gastrointestinal complication characterized by bowel wall inflammation and necrosis, predominantly affecting the cecum and ascending colon in immunocompromised patients, particularly those undergoing chemotherapy for hematological malignancies 1.Diagnosis
Clinical Presentation: Abdominal pain, fever, and diarrhea are common 1.
Imaging: Thickening of the bowel wall on imaging studies 1.
Laboratory Findings: Elevated inflammatory markers, leukocytosis with left shift, or leukopenia 1.
Diagnostic Criteria: No standardized grading system universally accepted; clinical suspicion and imaging findings crucial 1.Management
Initial Treatment: Broad-spectrum antibiotics and bowel rest are primary interventions 1.
Adjunctive Measures: Supportive care including fluid resuscitation, management of sepsis, and monitoring for complications 1.
Surgical Intervention: Emergent colectomy considered in cases with abdominal distension, hemodynamic failure, respiratory failure, multi-organ failure, or ICU admission 2.Special Populations
Comorbidities: No specific guidance provided for comorbidities; management tailored to individual patient status 12.Key Recommendations
Initiate broad-spectrum antibiotics and bowel rest for suspected neutropenic typhlitis (Evidence: Moderate 1).
Consider emergent surgical intervention (colectomy) in patients presenting with severe complications such as hemodynamic instability, respiratory failure, or multi-organ dysfunction (Evidence: Moderate 2).
Closely monitor patients for signs of sepsis and provide supportive care including fluid resuscitation (Evidence: Expert opinion 1).References
1 Nematolahi S, Amanati A, Vardanjani HM, Pourali M, Bensenjan MH, Nozari F et al.. Investigating neutropenic enterocolitis: a systematic review of case reports and clinical insights. BMC gastroenterology 2025. link
2 Vergara-Fernández O, Trejo-Avila M, Solórzano-Vicuña D, Santes O, Salgado-Nesme N. Factors associated with emergent colectomy in patients with neutropenic enterocolitis. Langenbeck's archives of surgery 2019. link
3 Lingaratnam S, Slavin MA, Mileshkin L, Solomon B, Burbury K, Seymour JF et al.. An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009. Internal medicine journal 2011. link