Neutropenic Colitis (Typhlitis)

 Massive mural thickening of cecal ± ascending colon wall

– Other segments of colon and small bowel can be affected

image Mucosal hyperenhancement and submucosal edema (marked)

image Infiltration of pericolonic fat

• Less common, more severe findings
image Pneumatosis, extraluminal gas and fluid (perforation)


• Pseudomembranous colitis

• Cecal diverticulitis

• Crohn colitis


• Severely neutropenic patients

• Majority of cases are those with leukemia &/or hematopoietic stem cell transplant recipients

• Pathogenesis: Probably due to combination of factors
image Mucosal injury by cytotoxic drugs

image Profound immunosuppression

image Invasion of bowel wall by microorganisms (polymicrobial)

image Progressive necrosis of bowel wall


• Fever, RLQ tenderness in immunosuppressed patient

• Watery diarrhea, ± hematochezia


• Consider history of chemotherapy for leukemia or bone marrow transplantation

(Left) This 25-year-old woman was receiving chemotherapy for synovial sarcoma and became severely neutropenic, with complaints of abdominal pain, fever, and diarrhea. Axial CECT shows marked submucosal edema of the cecum and ascending colon image.

(Right) Another CT section in the same patient shows mucosal hyperenhancement image and submucosal edema.

(Left) Coronal reformatted CT in the same patient shows inflammation of the ascending colon image and terminal ileum image, along with pericolonic ascites image.

(Right) Another coronal CT section in the same case shows pneumatosis image within the cecal wall, which, along with ascites image, suggested perforation, subsequently proven at surgery. Necrotizing, neutropenic colitis was the diagnosis.



• Neutropenic enterocolitis, ileocecal syndrome


• Life-threatening, necrotizing enterocolitis occurring primarily in severely neutropenic patients


General Features

• Best diagnostic clue
image Massive mural thickening of cecal ± ascending colon wall

• Location
image Cecum, ascending colon ± distal ileum
– Other segments of colon and small bowel can be affected

• Morphology
image Dilated/narrowed lumen, thickened wall

Radiographic Findings

• Radiography
image Ileocecal dilatation with air-fluid levels

image “Thumbprinting” in wall of ascending colon, ± pneumatosis

CT Findings

image Circumferential wall thickening of cecum ± ascending colon and distal ileum

image Decreased bowel wall attenuation due to edema

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Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Neutropenic Colitis (Typhlitis)

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