This patient had received induction chemotherapy with cytarabine and daunorubicine for acute myeolid leukemia. He developed abdominal pain, diarrhea and fever. The neutrophil count was 200 cells/microliter (normal >1,500 cells/microliter)
CT abdomen with oral and intravenous contrast
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The cecum, right colon, transverse colon and left colon as well as the distal 30cm or so of the ileum are thick walled and oedemtous. The sigmoid colon is spared. No obstruction or megacolon. No perforation or abscess. No lymphadenopathy.
A combination of localized and systemic symptoms is typical for neutropaenic enterocolitis. The right colon is most commonly affected, but in the neutropaenic patient, this condition should be considered even if only small bowel is involved.
- Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology. 2003;226 (3): 668-74. Radiology (full text) - doi:10.1148/radiol.2263011932 - Pubmed citation
- Vogel MN, Goeppert B, Maksimovic O et-al. CT features of neutropenic enterocolitis in adult patients with hematological diseases undergoing chemotherapy. Rofo. 2010;182 (12): 1076-81. doi:10.1055/s-0029-1245815 - Pubmed citation