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Management of neutropenic enterocolitis in children with cancer
Nicklas Sundell1, Håkan Boström, Mats Edenholm
1Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden. nicklas.sundell@vgregion.se
Insights
Severe typhlitis in children with cancer can be effectively managed with conservative treatment including bowel rest and antibiotics. Early diagnosis through clinical suspicion and imaging is key to successful outcomes.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Infectious Diseases
Background:
- Typhlitis, also known as neutropenic enterocolitis, is a serious complication in pediatric oncology patients.
- It is characterized by inflammation of the bowel wall, often associated with neutropenia and chemotherapy.
Purpose of the Study:
- To detail the clinical presentation, management strategies, and short-term outcomes of severe typhlitis in pediatric cancer patients.
- To identify predisposing factors and essential treatment components for typhlitis.
Main Methods:
- Retrospective analysis of twelve typhlitis episodes in 11 children treated at a pediatric oncology ward (1995-2006).
- Data collected included symptoms, radiological and laboratory findings, treatment interventions, and patient outcomes.
Main Results:
- Classical signs included neutropenia, fever, abdominal pain, and bowel wall thickening.
- All patients achieved successful outcomes with conservative management: bowel rest, broad-spectrum antibiotics, and supportive care.
- Three patients required surgery for complications post-recovery.
Conclusions:
- Early diagnosis is facilitated by high clinical suspicion and radiological imaging.
- Hematologic malignancy and recent chemotherapy are significant predisposing factors.
- Essential management involves supportive care, bowel rest (including parenteral nutrition), cytopenia correction, and aggressive antimicrobial therapy.
Aim:
To describe the symptoms, clinical management and short-term outcome in a series of paediatric oncology patients with severe typhlitis following conservative treatment.
Methods:
Twelve episodes of severe typhlitis in 11 children with cancer treated at the paediatric oncology ward at Queen Silvias Children's Hospital between 1995 and 2006 were analysed retrospectively. Data on symptoms, radiological findings, laboratory status and treatment as well as outcome were collected and analysed.
Results:
In all episodes, the classical signs of neutropenia, fever, abdominal pain and thickening of the bowel wall were present. All were successfully treated with bowel rest, broadspectrum antibiotics and supportive care. After recovery from typhlitis, three patients needed surgical intervention because of complications.
Conclusion:
A high clinical suspicion combined with radiological imaging aids early diagnosis. Predisposing factors for developing typhlitis were haematologic malignancy and treatment with chemotherapy within 3 weeks of onset. Supportive care, bowel rest including parenteral nutrition, correction of cytopenias and aggressive antimicrobial treatment is essential. Measurements of C-reactive protein in blood may be of benefit when assessing the clinical course.
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