Imaging and Clinical Features of Typhlitis in Pediatric Cancer Patients on Chemotherapy at Tikur Anbessa Specialized Hospital
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Date
2020-12
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Addis Abeba University
Abstract
Background: Typhlitis also known as neutropenic enterocolitis is a necrotizing enteropathy of
the right colon. It is characterized by the clinical triad of fever, abdominal pain, neutropenia and
imaging findings of right-side colonic inflammation. It is most often seen in the setting of severe
neutropenia in immunesuppressed patients who are undergoing treatment for malignancies, in
those who have undergone organ transplant(s) or have congenital or acquired causes of
immunesuppresion. We report the clinical and imaging findings of typhlitis in pediatric cancer
patients who have taken chemotherapy in the largest tertiary center in Addis Ababa, Ethiopia
over a period of 20 months.
Methods: Medical records of hospitalized patients were screened for plain radiograph,
ultrasound and computerized tomographic scan requests for suspected typhlitis in those on
inpatient cancer treatment (November 2018- July 2020 G.C). Retrospective case note analysis
was done to collect the clinical data of those with typhlitis.
Result: Typhlitis was identified in 4.2% (12/286) of the patients on chemotherapy. Eleven
patients (91.7%) had hematologic malignancies (leukemia, lymphoma), 1 patient had a solid
tumor (Head and neck embryonal RMS). Most (83.3%) had abdominal pain, diarrhea and
neutropenia. Fever was identified in 67.7% of patients. All had ultrasound evidence supportive of
typhlitis. All were treated with IV antibiotics. There were no complications requiring surgical
intervention. No child died during an episode of typhlitis.
Conclusion: The magnitude of typhlitis was found to be comparable to what is reported in other
studies. The clinical findings of abdominal pain, diarrhea, fever in a neutropenic patient who has
signs of colonic inflammation should prompt for the diagnosis of this case.
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Keywords
Typhlitis ,pediatric cancer, chemotherapy