Neutropenic typhlitis in adults
R. W. Ikard
Typhlitis is a necrotizing process of the cecum, occurring in neutropenic
patients who are usually receiving combined chemotherapy. The atonic cecum
is affected because of its poor arterial perfusion, the presence of colonic
bacteria, and the milieu of immunosuppression. It is a serious but not
inevitably fatal complication of the patient's basic illness. Resection of
necrotic bowel is necessary. Because this will usually be done on an
emergency basis in a very ill patient with unprepared bowel, a two-stage
procedure rather than primary anastomosis is advisable. Surgical results
may be better in adult than pediatric patients. The incidence of the
problem has probably increased since the advent of aggressive drug therapy
of the leukopathic states. Judging from the low number of reported adult
cases and the apparent inaccuracy of preoperative diagnosis, there may be
inadequate physician awareness of typhlitis.
