Advanced Practice - Neutropenic Enterocolitis
Neutropenic Enterocolitis aka typhlitis, necrotizing enterocolitis, ileocecal syndrome
- intestinal mucosal wall edema and disruption of wall integrity in a neutropenic patient
- Weakened immune system --> intestinal overgrowth --> invasion of opportunistic bacteria.
- May lead to sepsis and bowel perforation.
- Mortality 22%-50%.
- Most commonly seen in patients with hematologic malignancy receiving chemotherapeutic agents Symptoms:
- abdominal pain, fever (92%) and diarrhea. Pain is often diffuse.
- may be isolated to RLQ (ileocecal area).
- aggressive IV fluids, correct electrolyte imbalances, bowel rest
- broad spectrum antibiotics (ex. Cefepime and flagyl)
- surgical consultl (9% require surgery).
Lebon, D. et al. Gastrointestinal emergencies in critically ill cancer patients. J Crit Care. 2017; 40:69-75
Nesher, L, Rolston, KV. Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy. Clin Infect Dis. 2013; 56(5):711-7
Rodriguez, FG, et al. Neutropenic Colitis. World J Gastroenterol. 2017; 23(1); 42-47