Scenario: An immunocompromised patient who had several rounds to chemotherapy is transferred to Critical Care Unit due to fever, right lower quadrant tenderness, diarrhea and vomiting. A CT scan demonstrates marked thickening of colonic wall.
Daignosis: The diagnosis is Typhlitis or Neutropenic Enterocolitis. This is life threatening condition and bears high mortality. The treatment is supportive and management of complications, like intra abdominal abscess or perforated viscous. Neutropenic colitis is characterized by intramural bacterial invasion without an inflammatory reaction. It may lead to edematous thickening and induration of the cecal wall or other segments of the colon and distal small bowel. On CT the thickened cecum may be isodense to surrounding normal bowel or may contain intramural low density areas consistent with either edema, hemorrhage or necrosis, or pneumotosis. The differential diagnosis of cecal wall thickening associated with neutropenic colitis includes lymphomatous or leukemic intramural deposits and hemorrhage. Lymphomas and leukemia may occur simultaneously with neutropenic colitis.
Related: Neutropenic Enterocolitis in Lung Cancer: A Report of Two Cases and a Review of the Literature - Internal Medicine Vol. 44, No. 5 (May 2005)
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