Typhlitis in childhood cancer

Abstract

BACKGROUNDTyphlitis is increasingly recognized in children undergoing chemotherapy but is poorly characterized. The authors investigated the demographic, clinical, and imaging (ultrasonography and computed tomography [CT] scans) variables related to the diagnosis, risk, and outcome of typhlitis.METHODSThe authors reviewed the records of patients who had typhlitis (bowel wall thickness ≥ 0.3 cm plus clinical findings) during treatment at St. Jude Children's Research Hospital (Memphis, TN) between 1990 and 2001. They assessed whether duration of typhlitis was related to bowel wall thickness, extent of colonic involvement, ascites, demographics, primary diagnosis, symptoms of typhlitis, or duration of neutropenia. To identify risk factors for typhlitis, the authors compared the demographic data and previous drug therapy of 78 patients who had typhlitis and 1231 identically treated children who did not.RESULTSOf 3171 children, 83 (2.6%) developed typhlitis. Frequent symptoms were abdominal pain (91%), fever (84%), abdominal tenderness (82%), and diarrhea (72%). Twelve percent of the patients were not neutropenic. Duration of typhlitis was associated with bowel wall thickness measured by ultrasonography (n = 68; P = 0.05) but not CT scan (n = 48; P = 0.67) and was associated with duration of neutropenia (P = 0.02), fever (P = 0.01), and abdominal tenderness (P = 0.04). Age >16 years at cancer diagnosis was the only demographic factor associated with typhlitis (P = 0.03). Two patients died of typhlitis.CONCLUSIONSUltrasonography was a useful imaging modality for children with suspected typhlitis. The classic triad of abdominal pain, fever, and neutropenia may be absent. The severity of typhlitis was related to the duration of neutropenia and the presence of fever or abdominal tenderness. Cancer 2005. © 2005 American Cancer Society.

“Typhlitis” A Rare Diagnose For Emergency Room; Case Report

“…Typhlitis is encountered in increasing frequency, due to agressive chemotherapy applications [1][2][3]. McCarville et al [4] stated that the patients 16 years or older are more exposed to risk than the younger ones. Although the pathogenesis of this syndrome is not fully known, it is a result of cytotoxic therapies that harm the gastrointestinal canal mucosa, neutropenia, and the disruption of parasite defence mechanism [5].…”

Neutropenic Enterocolitis in a Child with Acute Myeloid Leukemia Successfully Treated with Early Surgical Intervention

“…The early management is by nasogastric decompression, bowel rest, antibiotics and supplemental parenteral nutrition. Surgery is indicated in cases with persistent gastrointestinal bleeding, bowel perforation, and uncontrolled sepsis [9]. In one study 117 cases of hematologic malignancies were enrolled, who were on various chemotherapeutic regimens, out of which 75.2 % had acute leukemias.…”

Neutropenic Enterocolitis in a Child With Acute Myelogenous Leukemia

“…But more recent reviews have shown improved survival rates (3). McCarville et al (4) reported 83 typhlitis case in 3171 children (2.6 %) with cancer and they reported an incidence of 3.3 % among patients with leukemia/lymphoma patients. Our clinic acute leukemias treated with chemotherapy neutropenic enterocolitis incidence rate about 4 %.…”

“…(2) There is general agreement that early management should be conservative and should consist of bowel rest, intravenous fluid administration, total parenteral nutrition, broad-spectrum antibiotics, and normalization of neutrophil counts. (2) In recently reported series surgical management is rarely performed and still Shamberger et al (8) criteria including; persistent gastrointestinal bleeding, bowel perforation, and uncontrolled sepsis are being used for surgical intervention (2,4).…”