Neutropenic enterocolitis (typhlitis) after pediatric bone marrow transplant

Area of Science:

• Pediatric Hematology
• Bone Marrow Transplantation
• Gastroenterology

Background:

• Neutropenic enterocolitis, also known as typhlitis, is a significant concern following bone marrow transplantation.
• This study focuses on the authors' experience with abdominal pain and typhlitis within a pediatric bone marrow transplant program.

Purpose of the Study:

• To review the incidence and management of abdominal pain and typhlitis in pediatric bone marrow transplant recipients.
• To evaluate the effectiveness of antibiotic therapy for typhlitis in this patient population.

Main Methods:

• A retrospective review of the Pediatric Bone Marrow Transplant Program Database was conducted.
• Patients presenting with abdominal pain or typhlitis between 1993 and 2000 were identified.

Main Results:

• Out of 142 transplants, 97 patients experienced abdominal pain, while 5 had radiologically confirmed typhlitis.
• Abdominal pain onset was around day 12 post-transplant; typhlitis was diagnosed around day 15.5.
• No clinical features distinguished between abdominal pain and typhlitis. All patients received prophylactic antibiotics; typhlitis cases received additional amphotericin and G-CSF.
• No surgical interventions were required, and no deaths were attributed to typhlitis.

Conclusions:

• Abdominal pain is a frequent post-bone marrow transplant symptom, but typhlitis is uncommon.
• Broad-spectrum antibiotic therapy, including antifungal agents, appears effective for treating typhlitis in pediatric bone marrow transplant patients.
• Surgical intervention was not necessary in this series of patients.