eMedicine Specialties > Gastroenterology > Colon
Neutropenic Enterocolitis: Follow-up
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 |
| « Previous Page | Next Page » |
References
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Further Reading
Related eMedicine Topics
- Colitis, Pseudomembranous [in the Radiology section]
- Necrotizing Enterocolitis [in the Radiology section]
- Necrotizing Enterocolitis, Surgical Treatment [in the Pediatrics: Surgery section]
- Neutropenia [in the Hematology section]
- Pseudomembranous Colitis [in the Infectious Disease section]
- Pseudomembranous Colitis, Surgical Treatment [in the General Surgery section]
- Typhlitis [in the Radiology section]
National Guideline Clearinghouse
- ACR Appropriateness Criteria® acute abdominal pain and fever or suspected abdominal abscess. American College of Radiology - Medical Specialty Society. 1996 (revised 2006). 7 pages. NGC:005138
- ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. American Society for Gastrointestinal Endoscopy - Medical Specialty Society. 2006 Apr. 8 pages. NGC:004977
- Evidence-based care guideline for necrotizing enterocolitis (NEC) among very low birth weight infants. Cincinnati Children's Hospital Medical Center - Hospital/Medical Center. 2005 Jul 14 (revised 2007 Feb). 12 pages. NGC:005522
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
Follow-up: Neutropenic Enterocolitis