Typhlitis: a treatable complication of acute leukemia therapy

Heretofore, pseudomembranous enterocolitis, or more specifically typhlitis, occurring as a complication of the cytotoxic chemotherapy of acute leukemia has nearly always resulted in a fatal outcome. Recent surgical literature states that if cecitis is found as a consequence of therapy for leukemia, the surgeon should refrain from operating because standard procedures, including hemicolectomy, have not improved survival. This paper reports two patients with acute typhlitis resulting from induction therapy of acute leukemia with cytosine arabinoside and hydroxydaunorubicin. Both patients underwent subtotal colectomy, while their marrows were aplastic from therapy, and survived their surgery. Both are living and well in maintained remission, 1 year from surgery. We review the pathogenesis of this disorder and discuss its clinical, x-ray, and laboratory features. Close oncologic/surgical teamwork is stressed as the patient is followed closely into the time frame when the decision is made whether to operate. Factors contributing to this decision are discussed. Preoperative recommendations are made in order to bring the patient into a state of physiologic stability. The operative procedure is described along with the postoperative complications encountered. We strongly recommend that laparotomy be considered in selected patients with typhlitis occurring as a complication of treated leukemia.