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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shameera Shaik Masthan MBBS, DLO, DNB[2]

Synonyms and keywords: Neutropenic colitis; Neutropenic enterocolitis; cecitis


Typhlitis is most commonly seen in neutropenic patients receiving chemotherapy for a cancer. It is also been seen in people with aplastic anemia, lymphoma, acquired immunodeficiency syndrome, as well as people who have had a kidney transplant. Typhlitis is distinguished by edema and inflammation of the cecum, ascending colon, and, in some cases, terminal ileum. Transmural necrosis, perforation, and mortality can occur as a result of the inflammation. The exact cause of the condition is unknown, but it is most likely caused by a combination of ischemia, infection (particularly with cytomegalovirus), mucosal hemorrhage, and possibly neoplastic infiltration. The treatment includes bowel rest, parenteral nutrition, antibiotics, and intensive fluid and electrolyte replacement.

Historical Perspective

  • In 1970, Wagner et al found and described typhlitis as necrotizing colitis after autopsy of 191 leukemic children with terminal illness at the Texas Children's Hospital, Baylor College of Medicine, Houston, between 1958 and 1970.[1]


  • There is no established system for the classification of Typhlitis.



Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Doxorubicin Hydrochloride, cytosine arabinoside, gemcitabine, vincristine, doxorubicin, cyclophosphamide, 5-fluorouracil, leucovorin, and daunorubicin are some of the drugs used to treat cancer.[6]Antibiotics, sulfasalazine, and immunosuppressive medication for organ transplantation[7][8]
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Adults with hematologic malignancies such leukemia, lymphoma, multiple myeloma, aplastic anemia, and myelodysplastic syndromes.[9]
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Differentiating Typhlitis from other Diseases

Typhlitis must be distinguished from other diseases that exhibit symptoms such as fever, abdominal pain, and diarrhea.[10]

Epidemiology and Demographics

Risk Factors

Common risk factors in the development of Typhlitis include hematological, solid tumors, neutropenic and Immunocompromised individuals.[20]


There is insufficient evidence to recommend routine screening for Neutropenic enterocolitis.

Natural History, Complications, and Prognosis


Neutropenic enterocolitis is typically diagnosed based on a combination of clinical and radiological findings.[23]

Diagnostic Study of Choice

There are no established criteria for the diagnosis of typhlitis.

History and Symptoms

The most common symptoms of typhlitis include fever, abdominal pain, and diarrhea. In severe cases, diarrhea can be bloody. Abdominal distension and paralytic ileus may also occur in patients.[24]

Physical Examination

Common physical examination of patients with Neutropenic enterocolitis is usually remarkable for Abdominal discomfort which can be diffuse or localized, with the right lower quadrant being the most common location. A rigid abdomen could be an indication of bowel perforation.[25]

Laboratory Findings

Laboratory findings consistent with the diagnosis of typhlitis include neutropenia with absolute neutrophil count <500 cells/microL, thrombocytopenia ranged from 4000/pl to 120,000/pl.[26]



An x-ray may be helpful in the diagnosis of Typhlitis but nonspecific. Findings on an x-ray suggestive of Neutropenic enterocolitis include inflated cecum with dilated small bowel loops, can detect free air.[28]

CT Scan


Medical Therapy


Primary Prevention

Effective measures for the primary prevention of Neutropenic enterocolitis include early detection and treatment can help to avoid problems and improve outcomes in patients who have undergone intensive chemotherapy or a stem cell transplant.Treatment with G-CSF not only speeds recovery from neutropenia episodes that occur during chemotherapy, but it also reduces the risk of consequences including mucositis.[34]

Secondary Prevention

Effective measures for the secondary prevention include early surgical evaluation in the management of this condition, as it can be life-saving for some patients who present with a complicated Neutropenic enterocolitis[35]


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