Typhlitis is an inflammation of the cecum, which is the beginning of the large intestine. It’s a serious illness that affects people who have a weak immune system, often from cancer, AIDS, or organ transplant. Sometimes it’s referred to as neutropenic enterocolitis, ileocecal syndrome, or cecitis.
It’s also sometimes called necrotizing enterocolitis, but necrotizing enterocolitis is also the name of a different illness that occurs in newborns. Typhlitis is a medical emergency that needs immediate treatment.
What Causes Typhlitis?
Doctors don’t know what exactly causes typhlitis. There are usually three elements involved: a weakened immune system, damage to the mucous membrane of the intestine, and neutropenia. Neutropenia occurs when you have lower levels of neutrophils, a type of white blood cell, than normal.
These conditions make it more likely that you’ll develop a bacterial infection. Chemotherapy can also cause damage to the intestines directly, or it can cause your digestive system to slow down. Both situations make bacterial infection more likely.
What Are the Symptoms of Typhlitis?
The symptoms of typhlitis can include:
- Abdominal pain and tenderness
- Fever
- Nausea
- Vomiting
- Diarrhea
- Low blood pressure
- Distended stomach
What Are Risk Factors for Typhlitis?
Typhlitis was first seen in children who had leukemia and a very low neutrophil count. The main risk factor for typhlitis is having a weak immune system that can’t fight off infection. It usually occurs in people undergoing chemotherapy or steroid therapy, including individuals who have the following conditions:
- Leukemia, which is most common
- AIDS
- Organ transplant
- Aplastic anemia, a disorder where your body stops making blood cells
- Lymphoma, a type of blood cancer
How Is Typhlitis Diagnosed?
It can be difficult to diagnose typhlitis because the symptoms are similar to other abdominal conditions. Symptoms can appear within two weeks of finishing chemotherapy. The most reliable way to diagnose typhlitis is through computed tomography (CT) scans.
Your doctor will listen to your symptoms and do a physical exam. You will also have blood tests and imaging studies. Typhlitis is diagnosed when the following criteria are met:
- Neutropenia
- Fever, although people with severe neutropenia may not have a fever
- Thickening of the bowel wall on CT or ultrasound
- Abdominal pain
- Distended abdomen
- Abdominal cramping
- Diarrhea
- Bleeding from the lower gastrointestinal (GI) tract
How Is Typhlitis Treated?
There is no standard treatment for typhlitis because there have not been many studies about which treatment works best. Your doctor will assess your symptoms and decide on a treatment path that would be best for you. These treatments may include:
- Antibiotics
- Intravenous (IV) fluid
- Bowel rest, which is not eating or drinking anything
- Use of a tube inserted through your nose into your stomach to drain stomach fluids
- Restoring electrolytes that are depleted, such as magnesium, sodium, and potassium
- Transfusions of blood products like platelets
- Surgery
What Are Possible Complications of Typhlitis?
Typhlitis complications are usually related to inflammation of the intestinal wall or problems associated with having low amounts of white blood cells, red blood cells, and platelets. These complications can include:
Perforation. This is a hole in your intestine that can let the contents of your intestine leak out into your abdominal cavity. This can cause an infection.
Peritonitis. This is an inflammation of the lining of your abdominal cavity. This can happen if there is a perforation.
Sepsis. This is a life-threatening condition that occurs when your body has an extreme response to an infection. Sepsis can cause tissue damage, organ failure, or death.
Abscess. This is a pocket of pus that can develop when you have an infection. It’s filled with dead tissue, white blood cells, and bacteria.
Severe bleeding. If your immune system is suppressed or compromised, you may also have a low platelet count, called thrombocytopenia. Platelets help your blood clot and stop bleeding. If you don’t have enough platelets, your body may not be able to stop bleeding.
What Is the Outlook for Typhlitis?
The prognosis for typhlitis has not been good. It has had a mortality rate of up to 50%, especially in people who have bowel perforation. People whose white blood cell count goes up tend to do better. In a 3-year review of children with leukemia, the mortality rate for those who developed typhlitis was 20%. However, with early diagnosis and treatment, the prognosis is improving.
If you are experiencing symptoms and think you may have typhlitis, reach out to your doctor. Together, you can go over all possible treatment options and decide which one would be best for you.
