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home - colon - various colitides - typhlitis Written by Dr Sebastian Zeki

typhlitis

Management :Conservative (antibiotics) if uncomplicated typhlitis /amphotericin B if protracted (>72hrs).Granulocyte colony stimulating factor (G-CSF) to increase the neutrophil count.Selective decontamination of the digestive tract.Enteral nutrition (for maintaining structural and functional integrity of the gut).Glutamine (for maintaining gut integrity and local and systemic immune function).Granulocyte transfusions as means of reducing the incidence or duration of typhlitis.With complicated typhlitis (ie perforation/ refractory bleeding/ peritonitis)- 2-stage right hemicolectomy with further chemotherapy after recovery IncidenceIt occurs in 46 % of childhood leukemia cases at autopsy.3.5 % of severe neutropoenic patients have this. Pathogenesis It involves neutropenia and cytotoxic drug damage which allows bacterial entry and bowel wall necrosis.It spreads from caecum into TI and ascending colon. 10-14d after cyto-toxic chemotherapy Clinical Manifestations:Neutropoenia and RLQ pain often.Abdominal distension,Nausea, vomiting and diarrheoa (bloody).Stomatitis and pharyngitis- suggests the presence of widespread mucositis. Cytotoxic drugs damage mucosa Neutropoenia Bacteria DiagnosisCT shows a fluid-filled, dilated, and distended caecum.There may be features to suggest abscess formation. Necrotizing enterocolitis (typhlitis) in adults Unproven benefit Mucosal necrosis may be present underneath unimpressive serosal inflammation so even if no gangrene oedematous bowel should be removed. Prognosis Written by Dr Sebastian Zeki 25%

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