Typhlitis, also called caecitis or neutropaenic colitis, is a necrotising inflammatory condition which typically involves the caecum and, sometimes, can extend into the ascending colon or terminal ileum.
Typhlitis was first described in children with leukaemia and severe neutropaenia. It most commonly occurs in immunocompromised patients, chemotherapy and steroid therapy patients including:
Clinically, patients with typhlitis present with a mixture of localised and systemic symptoms including a fever, chills, nausea, vomiting, diarrhoea, abdominal pain, tenderness and a distended abdomen. Peritoneal irritation and occult bloody stools may be present. Pain in the right lower quadrant may mimic appendicitis.
The condition is characterised by intramural bacterial invasion without an inflammatory reaction. This then leads to oedematous thickening and induration of the caecal wall or other mural segments of the colon and distal small bowel.
The exact cause is unknown but is believed due to a combination of ischaemia, infection (especially with cytomegalovirus, Pseudomonas aeruginosa), mucosal haemorrhage, and perhaps neoplastic infiltration 1.
Plain film findings are often non-specific. May show evidence of a small bowel obstruction (SBO), soft-tissue mass in right lower quadrant, thumbprinting due to bowel wall oedema intramural gas or bowel wall thickening.
Sonographic features are non-specific. Ultrasound may show thickening of bowel mucosa, intraluminal fluid, pericaecal fluid, abdominal abscess. A characteristic echogenic thickening of the mucosa has been reported in some paediatric reports 8.
This is often the imaging modality of choice in patients suspected of having typhlitis in view of high risks of perforation during colonoscopy or during a barium enema 5.
CT may demonstrate thickening of the caecum as well as fat stranding, pneumatosis intestinalis, bowel wall thickening and ileus. Features of small bowel obstruction may also be seen. There may be intramural areas of low attenuation which may represent haemorrhage or oedema 4.
Serial CT may also play a role in monitoring the success of treatment 5.
Arteriography is not part of the routine assessment. The entire caecum may be hypervascular, which may be seen as intense staining of the mucosa and its folds 2.
Treatment and prognosis
If possible, management should be conservative with IV antibiotics, nasogastric suctioning, and bowel rest. Any delay in diagnosis may result in transmural bowel necrosis. Surgical resection may be necessary for bleeding or bowel infarction.
For a terminal ileitis consider the differential diagnosis of a terminal ileitis.
History and etymology
Refers to "typhlós", ancient Greek word for "blind" (referring to the blind-ending caecum) 12.
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