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Typhlitis: A Real Pain in the Gut!

  • Kimberly BambachEmail author
  • Michael Purcell
Chapter

Abstract

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.

Keywords

Typhlitis Neutropenic enterocolitis Ileocecal syndrome Cytotoxic chemotherapy Neutropenia Neutropenic fever Oncologic emergency 

Notes

Disclosure Statement

The authors of this chapter report no significant disclosures.

References

  1. 1.
    Nesher L, Rolston KVI. Neutropenic Enterocolitis, a growing concern in the Era of widespread use of aggressive chemotherapy. Clin Infect Dis. 2012;56:711–7.CrossRefGoogle Scholar
  2. 2.
    Bow EJ, Meddings JB. Intestinal mucosal dysfunction and infection during remission-induction therapy for acute myeloid leukaemia. Leukemia. 2006;20:2087–92.CrossRefGoogle Scholar
  3. 3.
    Rolston KVI, Bodey GP, Safdar A. Polymicrobial infection in patients with cancer: an underappreciated and underreported entity. Clin Infect Dis. 2007;45:228–33.CrossRefGoogle Scholar
  4. 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
  5. 5.
    Katz JA, Mahoney DH, Fernbach DJ, Wagner ML, Gresik MV. Typhlitis. An 18-year experience and postmortem review. Cancer. 1990;65:1041–7.CrossRefGoogle Scholar
  6. 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. 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
  8. 8.
    Mccarville MB, Adelman CS, Li C, Xiong X, Furman WL, Razzouk BI, Pui C-H, Sandlund JT. Typhlitis in childhood cancer. Cancer. 2005;104:380–7.CrossRefGoogle Scholar
  9. 9.
    Gorschluter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IGH, Sauerbruch T, Glasmacher A. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75:1–13.CrossRefGoogle Scholar
  10. 10.
    McAninch S, Clinton C. Gastrointestinal emergencies. In: CURRENT diagnosis & treatment: emergency medicine. McGraw-Hill, Columbus, Ohio, USA. 2017.Google Scholar
  11. 11.
    Till M. Typhlitis in patients with HIV-1 infection. Ann Intern Med. 1992;116:998.CrossRefGoogle Scholar
  12. 12.
    Jumper C. Typhlitis and HIV. Ann Intern Med. 1992;117:698.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Emergency MedicineWexner Medical Center at The Ohio State UniversityColumbusUSA

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