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Typhlitis — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesTyphlitisSCE Medical Oncology

A 65-year-old woman with cancer develops typhlitis (neutropenic enterocolitis) presenting with right iliac fossa pain, fever and neutrophils 0.1 × 10⁹/L. CT abdomen shows caecal wall thickening and pneumatosis. What is the management?

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Correct answer: E — Conservative management: IV broad-spectrum antibiotics (piperacillin-tazobactam + metronidazole), bowel rest (nil by mouth), IV fluids, G-CSF and surgical consultation — surgery reserved for perforation, uncontrolled haemorrhage or clinical deterioration despite medical management

Typhlitis (neutropenic enterocolitis) is an inflammation/necrosis of the caecum occurring during chemotherapy-induced neutropenia. Conservative management is successful in approximately 60-80% of cases. Indications for emergency surgery include: perforation, uncontrolled bleeding, and clinical deterioration despite maximal medical therapy. Medical management includes: broad-spectrum antibiotics (covering Gram-negatives, anaerobes and consider fungal cover), bowel rest, IV fluids, G-CSF and close surgical monitoring. Mortality is approximately 30-50%.

Reference: NICE CG151; ESMO Oncological Emergencies; Gorschlüter et al Ann Hematol 2005