From the Guidelines
Typhlitis is primarily caused by severe neutropenia, which allows intestinal bacteria to invade the bowel wall, particularly in the cecum region, and the most common causes include chemotherapy for cancer, especially leukemia, as well as other immunosuppressive conditions 1. The pathophysiology of typhlitis involves damage to the intestinal mucosa combined with neutropenia, allowing normal gut bacteria to proliferate and invade the bowel wall, causing inflammation, edema, and potentially necrosis. Some key factors that contribute to the development of typhlitis include:
- Chemotherapy for cancer, particularly leukemia
- Bone marrow transplantation
- Aplastic anemia
- AIDS and other immunosuppressive conditions
- Specific chemotherapy agents such as cytarabine, doxorubicin, vincristine, and high-dose cyclophosphamide
- Prolonged antibiotic use that disrupts normal gut flora
- Steroid therapy
- Direct cytotoxic effects of chemotherapy on rapidly dividing intestinal cells
- Malnutrition and mucosal injury from medications According to the most recent study, neutropenic enterocolitis (typhlitis) is the commonest cause of acute abdominal pain in neutropenic cancer patients, typically occurring 1 or 2 weeks after chemotherapy is initiated 1. It is essential to note that typhlitis carries a high mortality rate if misdiagnosed or underestimated, and accurate differential diagnosis is mandatory 1. The diagnosis of typhlitis is often made based on clinical presentation, laboratory results, and imaging studies, such as CT scans or abdominal ultrasonography, which can show bowel wall thickening, fluid-filled bowel, ascites, and other signs of inflammation 1. In terms of management, treatment of neutropenic enteritis and typhlitis should be nonoperative, including broad-spectrum antibiotics and bowel rest, with emergency surgery reserved only for those patients presenting with signs of perforation or ischemia 1.
From the Research
Causes of Typhlitis
The causes of typhlitis are primarily associated with cancer chemotherapy, particularly in patients receiving intensive chemotherapeutic regimens that can induce mucosal damage [ 2 ]. Some key factors and conditions that contribute to the development of typhlitis include:
- Neutropenia: A condition characterized by an abnormally low number of neutrophils, which are a type of white blood cell important for fighting infections [ 3 ].
- Chemotherapy-induced neutropenia: This is a common cause of typhlitis, especially in patients with acute leukemia or those undergoing aggressive chemotherapy for other cancers [ 2,4 ].
- Immunocompromised state: Patients with compromised immune systems, such as those with cancer or undergoing immunosuppressive therapy, are at higher risk of developing typhlitis [ 5 ].
- Bacterial infections: The presence of certain bacteria, including Clostridium difficile, can contribute to the development of typhlitis [ 5 ].
- Poor arterial perfusion and the presence of colonic bacteria in the cecum: These factors can lead to a necrotizing process in the cecum, resulting in typhlitis [ 4 ].
Associated Conditions and Complications
Typhlitis can be associated with various complications and conditions, including:
- Septicaemia: A life-threatening condition that occurs when bacteria enter the bloodstream [ 6 ].
- Necrosis and perforation of the bowel: These are serious complications of typhlitis that can require surgical intervention [ 3 ].
- Clostridium difficile-associated diarrhea (CDAD): This condition can occur concurrently with typhlitis, as seen in a case report where a patient developed both conditions after chemotherapy [ 5 ].