Diagnostic Considerations

Consider neutropenic enterocolitis in the setting of critically ill neutropenic febrile patients with an acute abdomen, particularly when chemotherapeutic agents with known oral or gastrointestinal toxicity have been administered (eg, high-dose cytarabine).^[30]

Other conditions to consider in patients with suspected neutropenic enterocolitis include the following:

Intussusception
Ischemic colitis
Leukemic or lymphomatous infiltration of the bowel wall
Small bowel obstruction
Pseudomembranous colitis ^[30]
Digestive graft-versus-host disease ^[30]
Surgical acute abdomen ^[30]

Differential Diagnoses

Workup

Keidan RD, Fanning J, Gatenby RA, Weese JL. Recurrent typhlitis. A disease resulting from aggressive chemotherapy. Dis Colon Rectum. 1989 Mar. 32 (3):206-9. [QxMD MEDLINE Link].
Wade DS, Nava HR, Douglass HO Jr. Neutropenic enterocolitis. Clinical diagnosis and treatment. Cancer. 1992 Jan 1. 69 (1):17-23. [QxMD MEDLINE Link].
Davila AD, Willenbucher RF. Neutropenic typhlitis. In: Feldman M, Sleisenger MH, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 6th ed. Philadelphia, Pa: Saunders; 1998. 1998-2000.
Gorbach SL. Neutropenic enterocolitis. Clin Infect Dis. 1998 Oct. 27 (4):700-1. [QxMD MEDLINE Link].
Urbach DR, Rotstein OD. Typhlitis. Can J Surg. 1999 Dec. 42 (6):415-9. [QxMD MEDLINE Link].
Gorschluter M, Mey U, Strehl J, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005 Jul. 75 (1):1-13. [QxMD MEDLINE Link].
Davila ML. Neutropenic enterocolitis. Curr Opin Gastroenterol. 2006 Jan. 22 (1):44-7. [QxMD MEDLINE Link].
Ullery BW, Pieracci FM, Rodney JR, Barie PS. Neutropenic enterocolitis. Surg Infect (Larchmt). 2009 Jun. 10 (3):307-14. [QxMD MEDLINE Link].
Rodrigues FG, Dasilva G, Wexner SD. Neutropenic enterocolitis. World J Gastroenterol. 2017 Jan 7. 23 (1):42-7. [QxMD MEDLINE Link].
Wagner ML, Rosenberg HS, Fernbach DJ, Singleton EB. Typhlitis: a complication of leukemia in childhood. Am J Roentgenol Radium Ther Nucl Med. 1970 Jun. 109 (2):341-50. [QxMD MEDLINE Link].
Portugal R, Nucci M. Typhlitis (neutropenic enterocolitis) in patients with acute leukemia: a review. Expert Rev Hematol. 2017 Feb. 10 (2):169-74. [QxMD MEDLINE Link].
Gorschluter M, Mey U, Strehl J, et al. Invasive fungal infections in neutropenic enterocolitis: a systematic analysis of pathogens, incidence, treatment and mortality in adult patients. BMC Infect Dis. 2006 Feb 26. 6:35. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Aug. 65 (2):251-3. [QxMD MEDLINE Link].
Ishikawa M, Nakayama K, Razia S, et al. Neutropenic enterocolitis-induced sepsis and disseminated intravascular coagulation after chemotherapy: a case report. BMC Womens Health. 2021 May 3. 21(1):187. [QxMD MEDLINE Link]. [Full Text].
Marie I, Robaday S, Kerleau JM, Jardin F, Levesque H. Typhlitis as a complication of alemtuzumab therapy. Haematologica. 2007 May. 92 (5):e62-3. [QxMD MEDLINE Link].
Kasturi KS, Mummadi RR, Sood GK. Neutropenic enterocolitis: an unusual complication of HCV combination therapy with PEG-IFN and ribavirin. Eur J Intern Med. 2008 Jul. 19 (5):372-3. [QxMD MEDLINE Link].
Kim JH, Jang JW, You CR, You SY, Jung MK, Jung JH. Fatal neutropenic enterocolitis during pegylated interferon and ribavirin combination therapy for chronic hepatitis C virus infection. Gut Liver. 2009 Sep. 3 (3):218-21. [QxMD MEDLINE Link].
Katz JA, Wagner ML, Gresik MV, Mahoney DH Jr, Fernbach DJ. Typhlitis. An 18-year experience and postmortem review. Cancer. 1990 Feb 15. 65 (4):1041-7. [QxMD MEDLINE Link].
Shamberger RC, Weinstein HJ, Delorey MJ, Levey RH. The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer. 1986 Feb 1. 57 (3):603-9. [QxMD MEDLINE Link].
Fike FB, Mortellaro V, Juang D, St Peter SD, Andrews WS, Snyder CL. Neutropenic colitis in children. J Surg Res. 2011 Sep. 170 (1):73-6. [QxMD MEDLINE Link].
Jain Y, Arya LS, Kataria R. Neutropenic enterocolitis in children with acute lymphoblastic leukemia. Pediatr Hematol Oncol. 2000 Jan-Feb. 17 (1):99-103. [QxMD MEDLINE Link].
Buyukasik Y, Ozcebe OI, Haznedaroglu IC, et al. Neutropenic enterocolitis in adult leukemias. Int J Hematol. 1997 Jul. 66 (1):47-55. [QxMD MEDLINE Link].
Aksoy DY, Tanriover MD, Uzun O, et al. Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis. Ann Oncol. 2007 Jan. 18 (1):183-9. [QxMD MEDLINE Link].
Gil L, Poplawski D, Mol A, Nowicki A, Schneider A, Komarnicki M. Neutropenic enterocolitis after high-dose chemotherapy and autologous stem cell transplantation: incidence, risk factors, and outcome. Transpl Infect Dis. 2013 Feb. 15 (1):1-7. [QxMD MEDLINE Link].
El-Matary W, Soleimani M, Spady D, Belletrutti M. Typhlitis in children with malignancy: a single center experience. J Pediatr Hematol Oncol. 2011 Apr. 33 (3):e98-100. [QxMD MEDLINE Link].
Mullassery D, Bader A, Battersby AJ, 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. 2009 Feb. 44 (2):381-5. [QxMD MEDLINE Link].
Groudan K, Ready A, Sabir R. Neutropenic enterocolitis complicating induction chemotherapy in an acute myeloid leukemia patient. Cureus. 2021 Jan 31. 13(1):e13029. [QxMD MEDLINE Link]. [Full Text].
Ettinghausen SE. Collagenous colitis, eosinophilic colitis, and neutropenic colitis. Surg Clin North Am. 1993 Oct. 73 (5):993-1016. [QxMD MEDLINE Link].
Park YB, Lee JW, Cho BS, et al. Incidence and etiology of overt gastrointestinal bleeding in adult patients with aplastic anemia. Dig Dis Sci. 2010 Jan. 55 (1):73-81. [QxMD MEDLINE Link].
[Guideline] Schnell D, Azoulay E, Benoit D, et al. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF). Ann Intensive Care. 2016 Dec. 6 (1):90. [QxMD MEDLINE Link].
Rizzatti M, Brandalise SR, de Azevedo AC, Pinheiro VR, Aguiar Sdos S. Neutropenic enterocolitis in children and young adults with cancer: prognostic value of clinical and image findings. Pediatr Hematol Oncol. 2010 Sep. 27 (6):462-70. [QxMD MEDLINE Link].
Dietrich CF, Hermann S, Klein S, Braden B. Sonographic signs of neutropenic enterocolitis. World J Gastroenterol. 2006 Mar 7. 12 (9):1397-402. [QxMD MEDLINE Link].
Cartoni C, Dragoni F, Micozzi A, et al. Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol. 2001 Feb 1. 19 (3):756-61. [QxMD MEDLINE Link].
McCarville MB, Adelman CS, Li C, et al. Typhlitis in childhood cancer. Cancer. 2005 Jul 15. 104 (2):380-7. [QxMD MEDLINE Link]. [Full Text].
Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology. 2003 Mar. 226 (3):668-74. [QxMD MEDLINE Link]. [Full Text].
Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics. 2000 Mar-Apr. 20 (2):399-418. [QxMD MEDLINE Link]. [Full Text].
Spencer SP, Power N, Reznek RH. Multidetector computed tomography of the acute abdomen in the immunocompromised host: a pictorial review. Curr Probl Diagn Radiol. 2009 Jul-Aug. 38 (4):145-55. [QxMD MEDLINE Link].
Sullivan PS, Moreno C. A multidisciplinary approach to perianal and intra-abdominal infections in the neutropenic cancer patient. Oncology (Williston Park). 2015 Aug. 29 (8):581-90. [QxMD MEDLINE Link].
Zafrani L, Azoulay E. How to treat severe infections in critically ill neutropenic patients?. BMC Infect Dis. 2014 Nov 28. 14:512. [QxMD MEDLINE Link].
[Guideline] Andreyev HJ, Davidson SE, Gillespie C, Allum WH, Swarbrick E, British Society of Gastroenterology, et al. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut. 2012 Feb. 61 (2):179-92. [QxMD MEDLINE Link]. [Full Text].
Cardona Zorrilla AF, Reveiz Herault L, Casasbuenas A, Aponte DM, Ramos PL. Systematic review of case reports concerning adults suffering from neutropenic enterocolitis. Clin Transl Oncol. 2006 Jan. 8 (1):31-8. [QxMD MEDLINE Link].
Gafter-Gvili A, Fraser A, Paul M, Leibovici L. Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med. 2005 Jun 21. 142 (12 pt 1):979-95. [QxMD MEDLINE Link].
Kuderer NM, Dale DC, Crawford J, Lyman GH. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol. 2007 Jul 20. 25 (21):3158-67. [QxMD MEDLINE Link].
Kaito S, Sekiya N, Najima Y, et al. Fatal neutropenic enterocolitis caused by Stenotrophomonas maltophilia: a rare and underrecognized entity. Intern Med. 2018 Dec 15. 57(24):3667-71. [QxMD MEDLINE Link]. [Full Text].
Miller EE, Reardon LC. Neutropenic enterocolitis in a pediatric heart transplant recipient on multiple immunosuppressants. Case Rep Transplant. 2018. 2018:3264921. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Neutropenic enterocolitis. Ulcerative oral mucositis lesion on the lateral and ventral surfaces of the tongue.
Neutropenic enterocolitis. Colonic pseudomembranes of pseudomembranous colitis. Photographs courtesy of Eric M. Osgard, MD.
Neutropenic enterocolitis. Frontal abdominal radiograph in a patient with proved pseudomembranous colitis. Note the nodular haustral thickening, most pronounced in the transverse colon.
Neutropenic enterocolitis. Perforated appendicitis with abscess; computed tomography scan. Note the appendicolith (arrow) and air within the abscess. The terminal ileum lies anterior to the appendiceal abscess, and inflammatory change is noted in its wall, which appears thickened (open arrow).
Neutropenic enterocolitis. Plain abdominal radiograph in a 44-year-old man known to have a long history of ulcerative colitis. The patient presented with an acute exacerbation of symptoms. Image shows thumbprinting in the region of the splenic flexure of the colon.
Typhlitis. Marked asymmetric cecal wall thickening (arrow) in a 64-year-old patient whose status is postchemotherapy for lymphoma.
Typhlitis. Marked circumferential cecal and ascending colon wall thickening (large arrows) with mild pericolonic inflammatory stranding (small arrows).

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Author

Keith Sultan, MD, FACG Assistant Professor of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine

Keith Sultan, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Rajeev Vasudeva, MD Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD 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, South Carolina Medical Association

Disclosure: Received honoraria from Pricara for speaking and teaching; Received consulting fee from UCB for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ 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: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Neutropenic Enterocolitis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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