Typhlitis is inflammation of the cecum, which can lead to necrosis and sepsis. It is often seen in immunosuppressed patients and has a mortality rate of up to 50%. Treatment options include conservative management and surgery.
Typhlitis, also known as neutropenic enterocolitis, is inflammation of the cecum, a pouch at the beginning of the large intestine. This condition may be accompanied by inflammation of the appendix or ileum, the final section of the small intestine. Inflammation of the cecum often leads to necrosis, or tissue death, of the affected structures. There are several risk factors and correlates for this, but the underlying cause is not well understood. Possible causes include damage to the stomach lining from 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 is typically the result of necrosis of the intestine, followed by a systemic inflammatory state called sepsis.
First described in the 1960s in people being treated for leukemia, typhlitis has also been seen in people with lymphoma, aplastic anemia, and AIDS, as well as people being treated for several other types of cancer. This inflammatory condition poses a significant risk to children receiving chemotherapy as a treatment for leukemia and is a risk to people who are immunosuppressed following an organ transplant.
Symptoms are similar to symptoms of acute appendicitis, with the most common pattern involving 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 regimen for typhlitis. Some medical professionals prefer a modality of care called conservative management and others believe that surgery offers the best opportunity for a good outcome. Furthermore, it appears that treatment outcome is often dependent on the patient’s condition rather than the type of treatment used, so it is determined on a case-by-case basis.
Conservative management is a treatment regimen 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 feedings and nasogastric aspiration, in which stomach contents are drained through a tube rather than being allowed into the intestines. This strategy allows the intestines to rest and promotes healing. Broad-spectrum antibiotics are used to control the infection, and antifungal medications may be used.
The surgical alternative is typically considered for patients who have not responded to the conservative management treatment strategy. Typically, the surgery itself is done on a case-by-case basis, and the surgeon may not decide how to proceed with the operation until he has actually seen the intra-abdominal area. Possible surgical options include catheterization of the cecum to aid drainage and removal of part or all of the colon.
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