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Embolisation for caecal bleeding in a child with typhlitis.

Manou S de Lijster1, Anne M Smets, Henk van den Berg

  • 1Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands, m.s.delijster@amc.uva.nl.

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Summary

A teenage leukemia patient experienced typhlitis and severe bleeding during chemotherapy. Embolisation successfully treated the life-threatening condition, stabilizing the patient.

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Area of Science:

  • Oncology
  • Hematology
  • Gastroenterology

Background:

  • Acute promyelocytic leukemia (APL) relapse treatment involves intensive chemotherapy.
  • Neutropenia during chemotherapy increases susceptibility to infections and complications like typhlitis.

Observation:

  • A 16-year-old female with relapsed APL developed typhlitis (inflammation of the cecum and ascending colon) due to Klebsiella septicaemia.
  • The complication arose during the neutropenic phase, two weeks into induction chemotherapy.
  • Massive rectal blood loss and hemodynamic instability occurred despite parenteral feeding and antibiotics.

Findings:

  • Contrast-enhanced abdominal CT revealed contrast extravasation in the cecal lumen, indicating active bleeding.
  • Visceral angiography confirmed a contrast blush in the cecum, pinpointing the bleeding source.
  • Embolisation of the bleeding vessel effectively controlled the hemorrhage and stabilized the patient's hemodynamics.

Implications:

  • Typhlitis is a serious complication in neutropenic patients undergoing chemotherapy for leukemia.
  • Early diagnosis using imaging like CT and angiography is crucial for managing severe gastrointestinal bleeding.
  • Vascular interventions such as embolisation can be life-saving in cases of intractable bleeding from typhlitis.