What is Neutropenic Enterocolitis or Typhlitis?
Neutropenic enterocolitis or typhlitis is a fatal and incisive necrotizing enterocolitis which fall out mainly in neutropenic patient . Neutropenic enterocolitis is also known as “ ileocecal syndrome , ” “ necrotizing enterocolitis , ” “ typhlenteritis ” and less usually “ caecitis orcecitis . ” Neutropenic enterocolitis or typhlitis is commonly seen in patients who suffer from hematologic malignancies , who are myelosuppressed and are neutropenic . Being neutropenic mean that the patient role has decreased horizontal surface of neutrophil granulocytes . Such patient will have dislocation of wholeness of the gut mucosa due to cytotoxicchemotherapyi.e . treatment take for cancer . “ Typhlitis ” is derive from the Greek word “ typhlon , ” which means cecum , where there is neutropenic enterocolitis in the ileocecal region .
Neutropenic enterocolitis or typhlitis patient has lighting of the cecum , and there can also be inflammation of the ileum or appendix . Inflammation of the blind gut usually results in necrosis of the touch structures .
The exact cause of neutropenic enterocolitis or typhlitis is not clearly sympathise . There are multiple danger element and some of the potential causes let in damage to the mucosal lining of the stomach from trauma , infection or cytotoxic drugs . redness of the cecum is an extremely serious condition , as it can lead to far-flung infection . Death of the neutropenic enterocolitis or typhlitis affected role ordinarily go on due to mortification of the bowel , which is followed by sepsis where there is systemic rubor in the body .
ab initio neutropenic enterocolitis or typhlitis was described in child who were undergoing treatment for ( chemotherapy ) cancer of the blood . However , during the course of past 3 decades , this consideration has been increasingly found in adults who are hurt from different type of hearty malignant tumors , myeloproliferative disorders and along with bone marrow and solid organ transplanting due to immunosuppression . In some grownup , neutropenic enterocolitis occur due to increased use of myelotoxic chemotherapeutic regimens .
There are can be dramatic changes in the patient from neutropenic enterocolitis or typhlitis and the result of the disease can be very withering . The medical prognosis of neutropenic enterocolitis or typhlitis is very poor with the fatality rate rates being high , about up to 50 % on average . Treatment for neutropenic enterocolitis or typhlitis is quite controversial and comprises of different option which ranges from conservative treatment measures to surgery . It is very important that neutropenic enterocolitis or typhlitis is diagnose ahead of time and the handling is started immediately for a potentially better forecast .
Pathophysiology of Neutropenic Enterocolitis or Typhlitis
The precise case and the methodology of the advancement of neutropenic enterocolitis or typhlitis is not clear , however , acute neutropenia seems to be the constant feature . The pathophysiology of neutropenic enterocolitis can only take cecum , or it can extend to the ascending Costa Rican colon , ileum or both . Distension of the cecum causes restrictive ancestry supplying , which can predispose the caecum more to damage or trauma than other structures .
There are various ingredient which are retrieve to potentially encounter a role in the pathogenesis of neutropenic enterocolitis or typhlitis and these comprise of :
Cytotoxic Drugs : Use of cytotoxic drug which cause injury to the mucous membrane ; however , mucosal injury can also occur in the absence of cytotoxic drug therapy . Neutropenia alone can also cause mucosal ulcer .
Restricted Blood Supply : Cecal distension causes hitch to the blood provision which adds to the mucosal damage .
Bacterial Invasion : Bacterial and in some cases , fungal invasion of the deflower wall of the bowel , which can lead to transmural redness , resulting in peritonitis and perforation . patient role ofttimes suffer from complications , such as bacteremia which is a frequent complication and less commonly fungemia .
medicament : Use of certain medications , such as antibiotic drug and steroids , as they are thought to contribute to changes in the intestinal bacterial vegetation and cause overgrowth of fungi .
Causes & Risk Factors of Neutropenic Enterocolitis or Typhlitis
This status was initially described in 1960 in patients who were being treated for leucaemia . After this time , neutropenic enterocolitis or typhlitis has been base in patients suffering from aplasticanemia , lymphoma , AIDSand also in those patients who were being treated for other types of cancer . kid who are undergo chemotherapy for cancer of the blood and individual who are on immunosuppressant therapy after an organ transplant are at an increased risk for neutropenic enterocolitis or typhlitis .
Neutropenic Enterocolitis or Typhlitis is most ordinarily seen in patient role who are immunocompromised , e.g. those patients who are undergo chemotherapy , suffering with AIDS , organ transplantation and senior individuals . Cytotoxic chemotherapeutic agents are thought to be responsible for majority of the case of neutropenic enterocolitis ; however , there are other shape which predispose some people to develop this status . Some of the cytotoxic chemotherapeutical factor lie of vinca alkaloid , C arabinoside and doxorubicin . There are other drugs which are also thought to be responsible for induce neutropenic enterocolitis and these admit docetaxel , paclitaxel , procainamide , 5 - fluorouracil , sulfasalazine , vinorelbine , cisplatin , carboplatin , leucovorin and gemcitabine .
Other than this , new casing of neutropenic enterocolitis have come forward which are connect with alemtuzumab which is the monoclonal antibody antibody along with pegylated interferon ( PEG - INF ) and ribavirin .
Other predisposing component for neutropenic enterocolitis or typhlitis consist of :
Signs & Symptoms of Neutropenic Enterocolitis or Typhlitis
The symptoms of Neutropenic Enterocolitis or Typhlitis resemble the symptoms of acute appendicitis , and expose a common normal that include pain in the ass and tenderness in the right lower quadrant of the abdomen , distended venter , diarrhea , chills , fever , nausea , vomiting , and abdominal warmheartedness or pain . Neutropenic enterocolitis or typhlitis patient almost always has neutropenia , where there is reduced degree of neutrophils .
Diagnosis of Neutropenic Enterocolitis or Typhlitis
diagnosing of neutropenic enterocolitis or typhlitis is made with a radiograph CT scan where thickening of the caecum is seen along with “ fat stranding . ”
Treatment of Neutropenic Enterocolitis or Typhlitis
Neutropenic Enterocolitis or Typhlitis is a aesculapian emergency and carries a very poor prognosis . This condition is life jeopardize and the outcome is reasonably skillful only if it is immediately diagnosed and sharply treated . Successful treatment of Neutropenic Enterocolitis or Typhlitis depends on early diagnosis , which can be done with recognise the symptoms and CT CAT scan , conservative or non - running treatment if the case is uncomplicated and elective proper hemicolectomy is urge to prevent return of Neutropenic Enterocolitis . There is no specific handling for Neutropenic Enterocolitis or Typhlitis . Some practician believe in conservative direction , whereas others commend surgery to cater best opportunity for a potentially proficient issue . Other than this , the outcome of treatment ordinarily depends more on the condition of the patient rather than intervention method acting used . So , treatment and issue differs from patient to patient .
Conservative Management for Neutropenic Enterocolitis or Typhlitis consist of monitoring and treating the symptom of the patient or else of taking aggressive approach for treating the suit of this precondition . Conservative management is think to be efficacious in neutropenic enterocolitis or typhlitis patient who do not parade signs of gastrointestinal hemorrhage , perforation , peritonitis or clinical worsening . Conservative treatment of Neutropenic Enterocolitis lie in of I.V. feeding and nasogastric suction where the abdomen content are debilitate through a tube instead of letting them being allowed to enter the bowel . By adopting this handling method , the bowel is allowed to rest and it help with healing . Patient is given broad - spectrum antibiotics to avail control the contagion . Other than this , anti - fungal medications can also be used . Recurrent Neutropenic Enterocolitis or typhlitis , however , was ofttimes seen after conservative direction this status .
The aggressive or operative treatment for neutropenic enterocolitis or typhlitis is recommended for those patients who are not respond to bourgeois discussion strategy . Surgery is usually performed on a affected role to patient foundation , and the sawbones will often decide on how to continue with the surgery after he/ she has viewed the intra - abdominal region of the patient hurt from neutropenic enterocolitis or typhlitis . Some of the surgical options dwell of catheterizing of the cecum to help with drain and removing a section of the Costa Rican colon or the intact El Salvadoran colon .
Complications of Neutropenic Enterocolitis or Typhlitis
Prognosis of Neutropenic Enterocolitis or Typhlitis
The prognosis of neutropenic enterocolitis or typhlitis is often inadequate , with gamy mortality rate that average about 45 - 50 % , as this condition is often associated with perforation of the bowel . The prognosis highly count on the f number at which the clean blood cell ( WBC ) count is restored in the patient role . The outcome of neutropenic enterocolitis or typhlitis can be in force if this circumstance is early and accurately diagnosed along with give aggressive medical and supportive treatment .
The excitation in neutropenic enterocolitis or typhlitis can spread to other region of the gut and there can also be distention of the cecum where its blood supply is completely make out off . This along with other factors result in necrosis and bowel perforation , which leads to sepsis and peritonitis which are fateful .
