Typhlitis (neutropaenic colitis)

Case contributed by Dr Kenny Sim

Presentation

Patient with B cell acute lymphoblastic leukaemia on hyper-CVAD chemotherapy regimen. Neutropaenic (0.0 x 10^9/L). Presents with new per rectum bleeding and diarrhoea.

Patient Data

Age: 45
Gender: Male
Modality: CT

There is wall thickening as well as diffuse intramural hypodensity affecting the caecum, ascending, transverse and the majority of the descending colon. The appendix is also inflamed and measures up to 9 mm. The terminal ileum is spared and has a normal appearance. The remainder of the large bowel and rectum are unremarkable. Note is made of relative medial positioning of the descending colon. This abnormal colonic bowel wall thickening is associated with surrounding colonic fat stranding, most pronounced adjacent to the caecum. There is also thickening of the parietal peritoneum adjacent to the caecum and ascending colon. Mesenteric venous congestion is noted. Moderate volume free intraperitoneal fluid pools predominantly within the pelvis. No enlarged mesenteric or para-aortic lymph nodes.

The liver, gallbladder, adrenal glands, pancreas and spleen have an unremarkable appearance. 15 mm hypodensity within the lower pole right kidney. Multiple right-sided renal cysts are again noted. Left kidney is unremarkable.

The imaged lung bases are clear. No suspicious osseous lesion.

Case Discussion

Neutropaenic colitis or typhlitis typically involves the caecum as in this case. Intramural hypodensity represents either oedema or haemorrhage.

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Case Information

rID: 33256
Case created: 5th Jan 2015
Last edited: 6th Oct 2015
Tag: colitis
Inclusion in quiz mode: Included

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