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Findings:CT scan of the abdomen and pelvis was performed at 10 mm. increments after the administration of oral and IV contrast. Comparison was made with previous examination performed approximately 5 weeks previously.
There is bowel wall thickening involving the cecum, ascending, and proximal transverse colon. In addition, there is stranding in the mesentary within the cecum and ascending colon region. When compared with the previous examination the bowel loops within this region appeared unremarkable at that time. In addition, the bowel loops on the current examination are fluid filled.
Impression: Bowel wall thickening with stranding of the mesentary. These findings in conjunction with the patient's clinical history supports the diagnosis of neutropenic colitis.
Diagnosis:Neutropenic colitis.
Discussion: The entity of neutropenic colitis has also been referred to by many different names such as necrotizing enterocolitis, necrotizing enteropathy, agranulocytic enterocolitis, neutropenic enterocolitis, and the ileocecal syndrome of leukemia. In addition the term typhlitis from the Greek meaning cecum is also utilized to designate an unexplained necrotizing colitis located mainly in the cecum of children with leukemia. Typhlitis is a necrotizing process of multifactoral origin that may extend beyond the cecum and may accompany conditions other than leukemia and occur in adults also.
Neutropenic colitis is characterized by intramural bacterial invasion without an inflammatory reaction. It may lead to edematous thickening and induration of the cecal wall or other segments of the colon and distal small bowel. On CT the thickened cecum may be isodense to surrounding normal bowel or may contain intramural low density areas consistent with either edema, hemorrhage or necrosis, or pneumotosis. The differential diagnosis of cecal wall thickening associated with neutropenic colitis includes lymphomatous or leukemic intramural deposits and hemorrhage. Lymphomas and leukemia may occur simultaneously with neutropenic colitis and both diseases may involve the bowel wall. Intramural hemorrhage and lymphomatous or leukemic deposits present as focal eccentric rather than diffuse bowel wall thickening. The CT findings in this case of diffuse cecal wall thickening suggests neutropenic colitis especially in lieu of patient's clinical history of presenting with fever, abdominal pain and neutropenia with a history of lymphoma and having recently undergone chemotherapy prior to bone marrow transplant.
References:
1. Frick MP, et al: Computed Tomography of Neutropenic Colitis,
American Journal of Roentgenology, 1984;143:763-765.
2. Taylor AJ, et al: Typhlitis in Adults. Gastrointestinal Radiology, 1985; 10:363-369.
3. Dudiak KM: Abdominal Case of the Day. American Journal of Roentgenology, 1993;160:1323-1327.
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