Neutropenic Enterocolitis Clinical Presentation

Updated: Jun 10, 2019
  • Author: Keith Sultan, MD, FACG; Chief Editor: BS Anand, MD  more...
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Presentation

History

Most patients who are affected with neutropenic enterocolitis are receiving antineoplastic drugs and are profoundly neutropenic (ie, < 1000 cells/μL).

The time course and severity of the clinical presentation of neutropenic enterocolitis is variable. Symptoms usually occur within 10-14 days after the initiation of cytotoxic chemotherapy. The typical presentation mimics that of acute appendicitis.

Symptoms include the following:

  • Right-lower-quadrant abdominal pain, which may be cramping and intermittent or a continuous dull ache
  • Fever
  • Watery or bloody diarrhea, [22] which occurs in about 25-45% of patients
  • Nausea
  • Vomiting
  • Abdominal distention

Oral and pharyngeal mucositis (see the image below) may manifest before the onset of colonic symptoms

Ulcerative oral mucositis lesion on the lateral an Ulcerative oral mucositis lesion on the lateral and ventral surfaces of the tongue.
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Physical Examination

Physical findings in patients with neutropenic enterocolitis vary according to the severity of the disease and the presence or absence of complications. The following may be noted:

  • Abdominal distention, hypoactive bowel sounds, and a tympanitic abdomen may suggest ileus
  • The abdomen may be markedly tender, especially in the right lower quadrant
  • The cecum may be palpated as a boggy mass
  • Rebound tenderness and rigidity may suggest colonic perforation
  • Shock may be present as a consequence of sepsis
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