Presentation
Abdominal pain, fever and diarrhoea in a patient with acute myeloid leukaemia on chemotherapy.
Patient Data
Increased wall thickness with mucosal hyper-enhancement in the terminal ileum, caecum and ascending colon accompanied by surrounding fat stranding and a few prominent pericolic lymph nodes. The appendix is also dilated and shows marked wall thickening. No signs of perforation are noted in the current study.
A small volume of free fluid is present in the pelvis.
There is a small simple cortical cyst in the right kidney and a few small parapelvic cysts in the left kidney.
Case Discussion
Terminal ileum, caecum and ascending colon inflammatory process in a patient with acute myeloid leukaemia on chemotherapy is highly suggestive of neutropenic enterocolitis, a necrotising inflammatory condition which typically originates in the caecum and, often extends into the ascending colon, appendix or terminal ileum, in an immunocompromised, usually neutropenic patient.
Barium studies and colonoscopy carry a significant risk of perforation and should be avoided.
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