Diferencia entre revisiones de «Neutropenic enterocolitis»

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==Background==
==Background==
[[File:Diameters of the large intestine.png|thumb|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]
*Also known as "typhlitis"
*Necrosis of bowel wall secondary to polymicrobial invasion
*Necrosis of bowel wall secondary to polymicrobial invasion
**Involves terminal ileum and colon
**Involves terminal ileum and colon
**May progress to full-thickness infarction/perforation
**May progress to full-thickness infarction/perforation
*Occurs 10-14d after cytotoxic therapy
 


==Clinical Features==
==Clinical Features==
*Fever
 
*RLQ pain
*Typically presents 10-14d after cytotoxic therapy
*Nausea
*[[Special:MyLanguage/neutropenic fever|Fever]]
*Vomiting
*[[Special:MyLanguage/RLQ pain|RLQ pain]]
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]]
 


==Differential Diagnosis==
==Differential Diagnosis==
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{{Oncologic emergencies DDX}}
{{Oncologic emergencies DDX}}
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{{Abd DDX RLQ}}
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==Evaluation==
===Workup<ref>Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.</ref>===
*CBC with [[Special:MyLanguage/neutropenia|neutropenia]], [[Special:MyLanguage/thrombocytopenia|thrombocytopenia]]
*Blood cultures positive in ~25-85%, frequently bowel organisms
*CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
*Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis


==Diagnosis==
===Workup===
CT A/P: cecal distention and wall thickening


==Management==
==Management==
#Bowel rest
 
#NG suction
*Bowel rest
#IVF
*[[Special:MyLanguage/NG tube|NG tube]] to suction
#Broad spec antibiotics
*[[Special:MyLanguage/IVF|IVF]]
*TPN
*Consider G-CSF, particularly neutropenia < 100/ml and severe disease<ref>Greil R, Psenak O, Roila F. ESMO Guidelines Working Group. Hematopoietic growth factors: ESMO recommendations for the applications. Ann Oncol. 2008;19(suppl 2:ii):116–1118.</ref>
*Broad spectrum antimicrobials, in particular against gut microbiota to include<ref>Gorschluter M, Mey U, Strehl J, Zinske C, Schepke M, Schmid F, Wolf IG, Sauerbruch T, Glasmacher A, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13.</ref>:
**[[Special:MyLanguage/Metronidazole|Metronidazole]] plus [[Special:MyLanguage/cefepime|cefepime]]
**[[Special:MyLanguage/Piperacillin-tazobactam|Piperacillin-tazobactam]]
**[[Special:MyLanguage/Amphotericin B|Amphotericin B]] when patient remains febrile, neutropenic for greater than 5 days despite broad spectrum antibiotics
*Surgical consult (possible need for right hemicolectomy)<ref>Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.</ref>
 


==Disposition==
==Disposition==
*Surgial consult (possible right hemicolectomy)
 
*Admit
 


==See Also==
==See Also==
*[[Neutropenic fever]]
 
*[[Special:MyLanguage/Neutropenic fever|Neutropenic fever]]
 
 
==References==
 
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:ID]]
[[Category:ID]]
[[category:Surgery]]
[[Category:Heme/Onc]]
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Revisión actual - 23:48 4 ene 2026


Background

Average inner diameters and ranges of different sections of the large intestine.[1]
  • Also known as "typhlitis"
  • Necrosis of bowel wall secondary to polymicrobial invasion
    • Involves terminal ileum and colon
    • May progress to full-thickness infarction/perforation


Clinical Features


Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

RLQ Pain


Evaluation

Workup[2]

  • CBC with neutropenia, thrombocytopenia
  • Blood cultures positive in ~25-85%, frequently bowel organisms
  • CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
  • Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis


Management

  • Bowel rest
  • NG tube to suction
  • IVF
  • TPN
  • Consider G-CSF, particularly neutropenia < 100/ml and severe disease[3]
  • Broad spectrum antimicrobials, in particular against gut microbiota to include[4]:
  • Surgical consult (possible need for right hemicolectomy)[5]


Disposition

  • Admit


See Also


References

  1. ↑ Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.
  2. ↑ Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.
  3. ↑ Greil R, Psenak O, Roila F. ESMO Guidelines Working Group. Hematopoietic growth factors: ESMO recommendations for the applications. Ann Oncol. 2008;19(suppl 2:ii):116–1118.
  4. ↑ Gorschluter M, Mey U, Strehl J, Zinske C, Schepke M, Schmid F, Wolf IG, Sauerbruch T, Glasmacher A, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13.
  5. ↑ Williams N, Scott AD. Neutropaenic enterocolitis : a continuing surgical challenge. Br J Surg. 1997;84(9):1200–1205.
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