Neutropenic enterocolitis

Neutropenic enterocolitis (NE) is a poorly understood and life-threatening complication most commonly associated with chemotherapy-induced neutropenia. While it is most often seen in patients with hematologic malignancies, it manifests itself in a broad range of diseases. The clinical presentation can be nonspecific, including fever, abdominal pain or distension, diarrhea, and intestinal bleeding; additionally, the differential diagnosis is broad, including Clostridium difficile colitis, graft-versus-host disease, and appendicitis. As the symptoms are similar across the differential, diagnosis of NE requires a combination of clinical and radiographic findings coupled with a high degree of clinical acumen. Bowel wall thickening of greater than 4 mm in the correct clinical setting is generally indicative of NE. Successful treatment hinges on timely recognition and prompt administration of broad-spectrum antibiotic therapy. Surgical intervention is reserved for complications related to bowel perforation and/or failure of medical management.