Critical Complication in Childhood Leukemia: Neutropenic Enterocolitis, Risk Factors, and Outcomes

Area of Science:

• Gastroenterology
• Pediatric Oncology
• Infectious Diseases

Background:

• Neutropenic enterocolitis (typhlitis) is a severe gastrointestinal complication in pediatric patients undergoing chemotherapy.
• It is characterized by inflammation of the cecum and distal ileum, often presenting with fever, abdominal pain, and neutropenia.

Purpose of the Study:

• To describe the clinical characteristics, imaging findings, and risk factors of typhlitis in pediatric patients with leukemia.
• To highlight the diagnostic criteria and management strategies for typhlitis in this vulnerable population.

Main Methods:

• A retrospective study evaluated 72 pediatric patients with leukemia diagnosed with typhlitis between August 2019 and March 2023.
• Diagnosis was based on neutropenia, clinical symptoms, and imaging (cecum wall thickness >3 mm on ultrasonography).
• Data collected included demographics, chemotherapy, clinical presentation, cultures, imaging, comorbidities, hospital stay, management, and mortality.

Main Results:

• The incidence of typhlitis was 36%, with common symptoms including abdominal pain (81.8%) and fever (48.1%).
• Klebsiella pneumonia was the most common organism isolated. Cecum and terminal ileum were most affected (37.7%), with a mean wall thickness of 4.6±1.7 mm.
• Median antibiotic treatment was 13 days; chemotherapy resumption was delayed by 13.6±15.5 days. Five percent of patients (4/72) died from typhlitis and sepsis.

Conclusions:

• Neutropenic enterocolitis is a significant clinical challenge in pediatric leukemia patients.
• Early suspicion, prompt diagnosis, and a multidisciplinary approach are essential for effective management.
• Gastrointestinal symptoms in neutropenic patients warrant thorough investigation for typhlitis.