Typhlitis (neutropenic colitis) is a potentially fatal infection of the cecum and ascending colon caused by enteric pathogens in patients with severe immunosuppression. It is most frequently seen in patients with acute leukemia receiving chemotherapy, but also occurs in the setting of AIDS, aplastic anemia, multiple myeloma, or bone marrow transplantation. Bacteria, viruses, and fungi penetrate the damaged cecal mucosa and proliferate due to the profound neutropenia. There is edema and inflammation of the cecum, ascending colon, and occasionally ileum. Fever, abdominal pain, nausea and diarrhea are presenting symptoms. Prompt diagnosis and supportive therapy with intensive antibiotics and fluids are required to prevent transmural necrosis and perforation. Surgical resection is indicated in patients with transmural necrosis, intramural perforation, abscess, or uncontrolled sepsis and gastrointestinal hemorrhage.

The inherent risks of bowel perforation caused by barium enemas and colonoscopies in these critically ill patients mean that CT is the study of choice in typhlitis. CT demonstrates circumferential mural thickening (1-3 cm) of the cecum, low density areas within the colonic wall secondary to edema, pericolonic inflammation and fluid, and in severe cases, pneumatosis. Clinically, CT is used to monitor decreases in mural thickness after therapy and to detect subtle pneumoperitoneum in cases of silent perforation or necrosis [6, 7].

Neutropenic Typhlitis

Fig. 2. Pseudomembranous colitis. There is mural and haustral thickening of the colon associated with submucosal edema (white arrow, enhancing muscularis propria; black arrow, enhancing mucosa)

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