Typhlitis: A Real Pain in the Gut!
Typhlitis is a necrotizing disorder of the bowels. It causes transmural inflammation, most commonly at the ileocecal junction, and primarily occurs in neutropenic patients. Patients classically present with abdominal pain and neutropenia. It may occur in the setting of malignancy following cytotoxic chemotherapy or in other instances of profound immunosuppression. Typhlitis may mimic more common conditions such as appendicitis and C. difficile colitis. Workup includes labs for sepsis and Computed Tomography (CT) as the imaging modality of choice. CT commonly demonstrates bowel wall thickening, dilation, and other inflammatory changes. Treatment includes early resuscitation and broad-spectrum antibiotics. Typhlitis is an oncologic emergency with a high mortality rate and complications such as lower GI bleeding, bowel necrosis, bowel perforation, and sepsis.
KeywordsTyphlitis Neutropenic enterocolitis Ileocecal syndrome Cytotoxic chemotherapy Neutropenia Neutropenic fever Oncologic emergency
The authors of this chapter report no significant disclosures.
- 4.Mickley M, et al. Oncologic and hematologic emergencies in children. In: Tintinalli’s emergency medicine: a comprehensive study guide. McGraw-Hill, Columbus, Ohio, USA. 2016.Google Scholar
- 6.Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin. 2011; https://doi.org/10.3322/caac.20124.
- 7.Block J, et al. Chapter 7: Atraumatic conditions of the abdomen. In: The atlas of emergency radiology. McGraw-Hill, Columbus, Ohio, USA. 2013.Google Scholar
- 10.McAninch S, Clinton C. Gastrointestinal emergencies. In: CURRENT diagnosis & treatment: emergency medicine. McGraw-Hill, Columbus, Ohio, USA. 2017.Google Scholar