eMedicine Specialties > Gastroenterology > Colon

Neutropenic Enterocolitis: Follow-up

Author: Keith Sultan, MD, Faculty Practice, Division of Gastroenterology, Hepatology and Nutrition, North Shore University Hospital, Manhasset, New York
Coauthor(s): Rajeev Vasudeva, MD, FACG, Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine
Contributor Information and Disclosures

Updated: Jul 9, 2009

Follow-up

Further Inpatient Care

  • The patient with neutropenic enterocolitis (typhlitis) must be monitored in an intensive care setting with serial abdominal examinations.
  • Use of recombinant granulocyte colony-stimulating factor (GCSF) may be considered in individual patients, depending on the clinical progression. Controlled trials using GCSF in this specific entity are lacking, although several case reports of a successful outcome have been reported in the literature. Moreover, a better understanding and definition of specific subsets of patients that may benefit from treatment or prevention of neutropenic enterocolitis (typhlitis) is needed.

Deterrence/Prevention

  • Withhold further chemotherapy until complete recovery from neutropenic enterocolitis (typhlitis).
  • Consider antibiotic prophylaxis in neutropenic patients. A meta-analysis by Gafter-Gvili  suggested an overall mortality benefit of antibiotic prophylaxis, although not specific to neutropenic enterocolitis (typhlitis).23
  • Another meta-analysis suggested a mortality benefit to primary prophylaxis with GCSFs in adult cancer patients, also not specific to neutropenic enterocolitis (typhlitis).24
  • Consider an elective right hemicolectomy in patients with neutropenic enterocolitis (typhlitis) who have successfully recovered and may require repeated courses of chemotherapy in the near future.1

Complications

  • Bowel perforation and peritonitis
  • Gastrointestinal bleeding
  • Gastrointestinal obstruction
  • Intra-abdominal abscess
  • Sepsis
  • Death

Prognosis

  • The prognosis of neutropenic enterocolitis (typhlitis) is generally poor, with mortality rates varying from 5% to 100% and averaging about 40-50%.
  • The prognosis depends highly on the rapidity of restoration of the white blood cell (WBC) count.
  • The potential for recovery from neutropenic enterocolitis (typhlitis) may be improved by early, accurate diagnosis along with aggressive and meticulous medical and supportive therapy.25

Miscellaneous

Medicolegal Pitfalls

  • Consider the possibility of neutropenic enterocolitis (typhlitis) in all patients who are immunosuppressed and have right lower quadrant pain.
  • Early recognition of this condition is paramount to reducing mortality rates and achieving a potentially good outcome.
  • Monitor the patient in an intensive care setting with frequent serial abdominal examinations.
  • Joint management by the medical and surgical teams is essential for optimal management of neutropenic enterocolitis (typhlitis).
 


More on Neutropenic Enterocolitis

Overview: Neutropenic Enterocolitis
Differential Diagnoses & Workup: Neutropenic Enterocolitis
Treatment & Medication: Neutropenic Enterocolitis
Follow-up: Neutropenic Enterocolitis
Multimedia: Neutropenic Enterocolitis
References
Further Reading
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References

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Further Reading

Related eMedicine Topics

National Guideline Clearinghouse

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Keywords

neutropenic enterocolitis, typhlitis, necrotizing enterocolitis, ileocecal syndrome, pseudomembranous colitis, typhlitis, acute ileocecal enterocolitis, transmural inflammation of the small bowel and large bowel in myelosuppression and immunosuppression, profound neutropenia, cecum, ileum, ascending colon, cecitis, right lower quadrant pain

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Contributor Information and Disclosures

Author

Keith Sultan, MD, Faculty Practice, Division of Gastroenterology, Hepatology and Nutrition, North Shore University Hospital, Manhasset, New York
Keith Sultan, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Rajeev Vasudeva, MD, FACG, Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine
Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association
Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Medical Editor

Robert J Fingerote, MD, MSc, BSc, FRCPC, Consultant, Clinical Evaluation Division, Biologic and Gene Therapies, Directorate Health Canada; Consulting Staff, Department of Medicine, Division of Gastroenterology, York Central Hospital, Richmond Hill, Ontario
Robert J Fingerote, MD, MSc, BSc, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas M Heuman, MD, FACP, FACG, AGAF, Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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