Typhlitis, also known as neutropenic enterocolitis, is inflammation of the cecum, a pouch at the beginning of the large intestine. This condition can be accompanied by inflammation of the appendix or ileum, the small intestine's final section. Inflammation of the cecum often leads to necrosis, or tissue death, of the affected structures. There are several risk factors and correlations for it, but the underlying cause is not well understood. Possible causes include damage to the mucosal lining of the stomach due to infection, injury, or cytotoxic drugs.
Inflammation of the cecum is particularly serious because it can lead to widespread infection, and this condition has a mortality rate of up to 50%. Death typically is the result of necrosis of the bowel, followed by a systemic inflammatory state called sepsis.
First described in 1960 in people being treated for leukemia, typhlitis has since also been noted in people with lymphoma, aplastic anemia, and AIDS, as well as in people treated for several other types of cancer. This inflammatory condition is a significant risk for children undergoing chemotherapy as a treatment for leukemia, and it is a risk for people who are immunosuppressed following an organ transplant.
Symptoms are similar to symptoms of acute appendicitis, with the most common pattern including pain and tenderness in the right lower quadrant of the abdomen, accompanied by fever, diarrhea, nausea and vomiting. This condition is almost always accompanied by neutropenia, which is a decrease in the blood level of a type of immune cell called a neutrophil.
There is no standard treatment regime for typhlitis. Some medical professionals favor a mode of care called conservative management, and others believe that surgery provides the best opportunity for a good outcome. In addition, it seems that the outcome of treatment is often dependent on the patient’s condition rather than on the type of treatment used, so it is determined on a case-by-case basis.
Conservative management is a treatment regime that involves monitoring and treating the patient’s symptoms rather than taking any direct action to treat the cause of the condition. Treatment includes intravenous feeding and nasogastric suction, in which the contents of the stomach are drained via a tube rather than being allowed to enter the bowel. This strategy allows the bowel to rest and promotes healing. Broad-spectrum antibiotics are used to control infection, and anti-fungal medications might be used.
The surgical alternative typically is considered for patients who have not responded positively to the conservative management treatment strategy. Generally, surgery itself is performed on a case-by-case basis, and the surgeon might not decide how to proceed with the operation until he or she has actually viewed the intra-abdominal area. Possible surgical options include catheterizing the cecum to aid in drainage and the removal of part or all of the colon.