Presentation
66-year-old male patient presenting with acute myeloid leukemia neutropenia secondary to chemotherapy. Ongoing severe diarrhea and abdominal pain.
Patient Data
Mild dilation of the small bowel (jejunal loops). No pneumoperitoneum. Colon gas patter is unremarkable.
There is thickened walls within the distal ileum associated with mild small bowel loops dilation and moderate amount of intraperitoneal free fluid. Colon demonstrates some distal diverticula, but is otherwise unremarkable. No free intraabdominal gas. The liver, spleen, pancreas, kidneys and adrenal glands are unremarkable. No lymph node enlargement. No suspicious bone lesions are seen. Small pleural effusion on the right. Conclusion: Features are those of ileitis consistent with neutropenic enterocolitis and associated with mild small bowel dilation and ascites. No evidence of bowel perforation.
Case Discussion
Features are those of inflammatory changes involving the distal ileum associated with ileus and ascites. Differentials would include those of terminal ileitis, including typhilitis (neutropaenic enterocolitis), which is the most likely diagnosis in this clinical scenario.
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