eMedicine Specialties > Radiology > Gastrointestinal

Typhlitis

Author: Thomas M Stoehr, MD, Staff Physician, Department of Diagnostic Radiology, Oregon Health Sciences University
Coauthor(s): D Bradley Koslin, MD, Director of Body Imaging and Professor, Department of Radiology, Oregon Health and Science University School of Medicine
Contributor Information and Disclosures

Updated: Apr 23, 2009

Introduction

Background

Typhlitis means inflammation of the cecum.

Typhlitis. Marked low-attenuation cecal wall thic...

Typhlitis. Marked low-attenuation cecal wall thickening (large arrow) with moderate pericolonic inflammatory stranding (small arrows). Note thickening of transverse colon wall posteriorly.

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Typhlitis. Marked low-attenuation cecal wall thic...

Typhlitis. Marked low-attenuation cecal wall thickening (large arrow) with moderate pericolonic inflammatory stranding (small arrows). Note thickening of transverse colon wall posteriorly.


Typhlitis. Marked asymmetric cecal wall thickenin...

Typhlitis. Marked asymmetric cecal wall thickening (arrow) in this 64-year-old patient whose status is postchemotherapeutic for lymphoma.

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Typhlitis. Marked asymmetric cecal wall thickenin...

Typhlitis. Marked asymmetric cecal wall thickening (arrow) in this 64-year-old patient whose status is postchemotherapeutic for lymphoma.


In 1960, Bierman and Amronin first coined the term ileocecal syndrome to describe inflammation and/or necrosis of the cecum, appendix, and/or ileum in patients with leukemia.1 Typhlitis subsequently has been associated with aplastic anemia, lymphoma, AIDS, and immunosuppression following renal transplantation or during treatment of malignancy.2,3,4

Pathophysiology

Pathologically, typhlitis represents inflammation and/or necrosis of the cecum, appendix, and/or ileum. The etiology of typhlitis is unknown, but its pathogenesis is multifactorial. Profound neutropenia, with total neutrophil counts of less than 1000/µL, appears to be a universal predisposing factor. Mucosal injury from cytotoxic drugs plays an important role in the typhlitis observed during chemotherapy.5,6,7

Cecal distention in typhlitis may impair the blood supply, leading to mucosal ischemia and ulceration. Infection may be involved, especially cytomegalovirus. Bacterial invasion leads to transmural penetration and, ultimately, perforation. Mucosal and submucosal necrosis can result in intramural hemorrhage. Neoplastic infiltration may be involved in some patients.

Frequency

United States

Typhlitis was found in 10% of leukemic children who died while undergoing chemotherapy.

Mortality/Morbidity

The mortality rate averages 40-50%, which is usually attributable to cecal perforation, bowel necrosis, and sepsis.

Sex

Prevalence rates are equal in males and females.

Age

Typhlitis occurs in both children and adults.

Anatomy

The maximum normal colonic wall thickness on CT is 3 mm. When the colon is distended with stool, fluid, or oral contrast, the normal colonic wall is nearly imperceptible. Pericolonic fat should demonstrate homogeneous fat attenuation.

Typhlitis is usually confined to the cecum, appendix, and terminal ileum; however, it can cause a pancolitis extending distally from the cecum.

Presentation

Typical presenting symptoms (of which time course and severity can vary considerably) include the following:

  • Watery or bloody diarrhea
  • Fever
  • Nausea
  • Vomiting
  • Abdominal pain (may be localized to right lower quadrant [RLQ])
  • Possible shock secondary to septicemia or colonic perforation

Physical examination findings include the following:

  • Abdominal distention
  • Absence of bowel sounds
  • Tympany
  • Palpation tenderness (usually most marked in RLQ)
  • Occasionally, a palpable mass
  • Diffuse direct and rebound tenderness (suggesting colonic perforation, peritonitis)

Preferred Examination

Abdominal CT with oral and intravenous contrast is the preferred examination.

Differential Diagnoses

Small-Bowel Obstruction

Other Problems to Be Considered

Infectious colitis

More on Typhlitis

Overview: Typhlitis
Imaging: Typhlitis
Multimedia: Typhlitis
References
Further Reading
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References

  1. Bierman HR, Amronin G. The ileocecal syndrome in the leukopathic conditions. Clin Res. 1960;8:134.

  2. Haut C. Typhilitis in the pediatric patient. J Infus Nurs. Sep-Oct 2008;31(5):270-7. [Medline].

  3. Abu-Hilal MA, Jones JM. Typhlitis; is it just in immunocompromised patients?. Med Sci Monit. Aug 2008;14(8):CS67-70. [Medline].

  4. Robaday S, Kerleau JM, Tapon E, Levesque H, Marie I. [Typhlitis: report of a case and review of the literature]. Rev Med Interne. Mar 2008;29(3):224-7. [Medline].

  5. Mullassery D, Bader A, Battersby AJ, Mohammad Z, Jones EL, Parmar C, et al. Diagnosis, incidence, and outcomes of suspected typhlitis in oncology patients--experience in a tertiary pediatric surgical center in the United Kingdom. J Pediatr Surg. Feb 2009;44(2):381-5. [Medline].

  6. Marie I, Robaday S, Kerleau JM, Jardin F, Levesque H. Typhlitis as a complication of alemtuzumab therapy. Haematologica. May 2007;92(5):e62-3. [Medline].

  7. Tiseo M, Gelsomino F, Bartolotti M, Barili MP, Ardizzoni A. Typhlitis during second-line chemotherapy with pemetrexed in non-small cell lung cancer (NSCLC): A case report. Lung Cancer. Apr 3 2009;[Medline].

  8. Alexander JE, Williamson SL, Seibert JJ. The ultrasonographic diagnosis of typhlitis (neutropenic colitis). Pediatr Radiol. 1988;18(3):200-4. [Medline].

  9. Dähnert W. Radiology Review Manual. Williams & Wilkins;1991:422.

  10. Feldman M, Sleisenger MH, Scharschmidt BF. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Vol 2. 6th ed. WB Saunders;1997:1998-2000.

  11. Frick MP, Maile CW, Crass JR. Computed tomography of neutropenic colitis. AJR Am J Roentgenol. Oct 1984;143(4):763-5. [Medline].

  12. Glass-Royal MC, Choyke PL, Gootenberg JE. Sonography in the diagnosis of neutropenic colitis. J Ultrasound Med. Nov 1987;6(11):671-3. [Medline].

  13. Katz JA, Wagner ML, Gresik MV. Typhlitis. An 18-year experience and postmortem review. Cancer. Feb 15 1990;65(4):1041-7. [Medline].

  14. Shamberger RC, Weinstein HJ, Delorey MJ. The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer. Feb 1 1986;57(3):603-9. [Medline].

  15. Wagner ML, Rosenberg HS, Fernbach DJ. Typhlitis: a complication of leukemia in childhood. Am J Roentgenol Radium Ther Nucl Med. Jun 1970;109(2):341-50. [Medline].

  16. Wall SD, Jones B. Gastrointestinal tract in the immunocompromised host: opportunistic infections and other complications. Radiology. Nov 1992;185(2):327-35. [Medline].

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Keywords

typhilitis, neutropenic colitis, necrotizing enterocolitis, ileocecal syndrome, cecitis, necrotizing inflammation of cecum, neutropenic typhlitis, gastroenteritis

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Contributor Information and Disclosures

Author

Thomas M Stoehr, MD, Staff Physician, Department of Diagnostic Radiology, Oregon Health Sciences University
Disclosure: Nothing to disclose.

Coauthor(s)

D Bradley Koslin, MD, Director of Body Imaging and Professor, Department of Radiology, Oregon Health and Science University School of Medicine
D Bradley Koslin, MD is a member of the following medical societies: American College of Radiology, Association of University Radiologists, Radiological Society of North America, Society of Gastrointestinal Radiology, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Medical Editor

Eric P Weinberg, MD, Associate Professor, Department of Radiology, University of Rochester Medical Center, Strong Memorial Hospital
Eric P Weinberg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Spencer B Gay, MD, Professor of Radiology, Director of Body Computed Tomography, Department of Radiology, University of Virginia Health Sciences Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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