Findings: CT scan demonstrates bowel wall thickening and enhancement involving the cecum and ascending colon from the level of hepatic flexure to the appendix. There is also thickening and edema of the adjacent fat. No free air or abnormal extraluminal fluid collections or masses are seen.

Diagnosis: Typhlitis.

Discussion: Typhlitis is a necrotizing inflammation of the colon and ileum seen in neutropenic patients. Typhlitis most commonly occurs in leukemia but may also develop in lymphoma, aplastic anemia, AIDS or after organ transplant. The exact cause is unknown but is believed to be secondary to bacterial overgrowth in the wall of the colon after chemotherapy. The cecum is the most frequently involved. Symptoms of typhlitis include fever, abdominal pain and distension, vomiting, diarrhea and bloody stools. The pain in the right lower quadrant may mimic appendicitis. The radiographic findings include those seen in this case. Pneumatosis intestinalis, wall thickening of bowel, ileus and small bowel obstruction can also be seen. These findings can be seen on CT and ultrasound.

References:
Donald R. Kirks: Practical Pediatric Imaging Diagnostic Radiology of Infants
and Children Second Edition, Lippincott-Raven 1998, 942-945.

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