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Typhilitis

Up Bowel ischaemia Clostridium difficile Diarrhoea GI bleed Hepatic failure Intra-abdominal infection Nutrition Oesophageal foreign body Oesophageal rupture Pancreatitis Pancreatoduodenectomy Pseudo-obstruction Stress ulceration Swallowing Typhilitis Ulcerative colitis


Also known as necrotizing enteropathy, ileocaecal syndrome and neutropaenic enterocolitis

Epidemiology

Occurs in immunosuppressed patients:

  • chemotherapy for leukaemia or solid tumours
  • immunosuppression for transplantation

Pathogenesis

  • unclear
  • ? drug induced mucosal injury combined with inhibition of cellular replication followed by superinfection with colonic organisms
  • ? caecum particularly prone to involvement because of poor vascular supply

Clinical features

  • symptom onset usually occurs while white cell count declining
  • nausea, vomiting
  • abdominal pain
  • ± diarrhoea (may be bloody)
  • pyrexia
  • right iliac fossa tenderness
  • physical signs may be minimal, even in severe cases
  • improvement usually delayed until white cell count begins to rise

Investigations

  • AXR usually normal or non-specific:
    • decreased gas in right lower quadrant with dilated small bowel loops
    • free intraperitoneal gas (if perforation has occurred)
    • "thumb printing
  • ultrasound
  • CT: terminal ileal, caecal and/or proximal colonic wall thickening

Management

Controversial

Conservative

  • gastric decompression
  • fluid and blood product replacement
  • broad spectrum antibiotics
  • ± parenteral nutrition
  • close observation with repeat CT to monitor progress and detect perforation

Surgery

  • some advocate early surgical intervention
  • definitive indications for surgery are:
    • perforation
    • generalized peritonitis
    • continued bleeding despite correction of thrombocytopaenia and coagulopathy

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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