No abstract available.
Typhlitis*

The cecal perforation is very rare in pediatrics. Our center has experienced a 7-year-old girl with idiopathic perforated cecitis. The surgeon couldn't differentiate perforated cecitis from perforated appendicitis because of anatomical location, incidence and ambiguous radiologic result when this patient was admitted to our clinic due to RLQ pain.
Appendicitis* ; Child ; Female ; Humans ; Incidence ; Pediatrics ; Typhlitis*

No abstract available.
Child* ; Humans ; Leukemia, Myeloid, Acute* ; Typhlitis*

Typhlitis is a necrotizing enterocolitis of the cecum, ascending colon and terminal ileum. Typhlits has been reported in the severely neutropenic patients and likely results from a combination of neutropenia and defects in the bowel mucosa related to cytotoxic chemotherapy. This disease is most common in patients with leukemia who have undergone intensive myeloablative chemotherapy. Presumptive diagnostic criteria for typhlitis include fever, abdominal pain and tenderness, and radiologic evidence of right-sided colonic inflammation in patients with neutropenia. Recently, this disease is also reported in patients with solid tumor due to increasing challenges of high dose chemotherapy. We report a case of typhlitis developed in the circumstance of neutropenia induced by chemotherapy in a patient with malignant testicular tumor.
Abdominal Pain ; Cecum ; Colon ; Colon, Ascending ; Drug Therapy* ; Enterocolitis, Necrotizing ; Fever ; Humans ; Ileum ; Inflammation ; Leukemia ; Mucous Membrane ; Neutropenia ; Typhlitis*

Typhlitis or neutropenic enterocolitis is a life-threatening, necrotizing process of the cecum whose incidence is increasing. Typhlitis presents as fever, abdominal pain, and diarrhea in neutropenic patients. As the incidence of typhlitis increases, emergency physicians must be aware of this rapidly progressive and potentially fatal disease. The definitive management of typhlitis is controversial. The most prudent course for the emergency physician is to initiate aggressive medical management early in the ED. We describe a 25-year-old man with severe neutropenia presented to the emergency department with fever, abdominal pain, diarrhea that began 2days earlier. Abdominal computerized tomography(CT) demonstrated diffuse concentric thickening of the cecal wall, intramural edema, inflammatory bowel changes but no free air and abscess formation. He was recovered by early diagnosis and aggressive medical therapy. We report a case of typhlitis with literature reviews.
Abdominal Pain ; Abscess ; Adult ; Cecum ; Diarrhea ; Early Diagnosis ; Edema ; Emergencies* ; Emergency Service, Hospital ; Enterocolitis, Neutropenic ; Fever ; Humans ; Incidence ; Neutropenia ; Typhlitis*

PURPOSE: Acute appendicitis and typhlitis are difficult problems in acute myeloid leukemia (AML) patients. Whereas the treatment of typhlitis is primarily conservative, acute appendicitis is managed by surgery. The difficulty lies in distinguishing between the two becauae they both present similar conditions, and before surgery or autopsy, differentiation of these disease is nearly impossible. Careful evaluation is necessary before considering surgical treatment. In order to determinate proper treatment, we have reviewed our experiences with the right lower quadrant (RLQ) abdominal pain in patients with AML. METHODS: From July 1990 to December 2001, at St. Mary's hospital, Seoul, Korea, the records of AML patients that were consulted to the surgical department for RLQ abdominal pain were reviewed. Thirty patients were consulted and 12 out of the 30 patients underwent surgery. RESULTS: The average age of the patients who underwent operation was 33.9, with 9 males and 3 females. Six patients were in complete remission, and the other 6 were in the active state. RLQ pain was the first symptom of AML in four patients. All 12 patients had RLQ pain and 10 had rebound tenderness. In three patients, the white blood cell (WBC) count was less than 1, 000/mm3. Appendectomy was performed in five patients, appendectomy with drainage was performed in five, and laparoscopic appendectomy was performed in two patients. The final diagnosis was periappendicial abscess in four cases, leukemic cell infiltration in three cases, adenocarcinoma in one case, and typhlitis in three patients. Four patients developed wound infection and one patient died due to sepsis 7 days after the operation. For the patients who were treated medically, the average age was 36, with 11 males and 7 females. Seven patients were in the active state, three patients were in CR, four patients were in the refractory state, and two patients were in relapse. Six patients died within one month because of sepsis or pneumonia. CONCLUSION: Surgery is safe and is the sole method that can improve the survival rate in patients with AML and RLQ abdominal pain. Furthermore, complications related to surgery may be reduced through the laparoscopic surgery.
Abdominal Pain ; Abscess ; Adenocarcinoma ; Appendectomy ; Appendicitis ; Autopsy ; Diagnosis ; Drainage ; Female ; Humans ; Korea ; Laparoscopy ; Leukemia ; Leukemia, Myeloid, Acute* ; Leukocytes ; Male ; Pneumonia ; Recurrence ; Seoul ; Sepsis ; Survival Rate ; Typhlitis ; Wound Infection

Neutropenic enterocolitis is an acute life-threatening, necrotizing inflammation of cecum and terminal ileum often seen in leukemia and lymphoma during periods of prolonged or severe neutropenia. It has been also referred to as necrotizing enterocolitis, ileocecal syndrome, or typhlitis (from the Greek word typhlon meaning cecum). The pathophysiology of the neutropenic enterocolitis is unknown but is believed to be multifactorial. The clinical symptoms of neutropenic enterocolitis are nonspecific including fever, abdominal pain (often right lower quadrant), abdominal distension, diarrhea, bloody stools, nausea, and vomiting. So acute appendicitis is should be included in the differential diagnosis. The early signs and symptoms are nonspecific and it may rapidly lead to intestinal perforation. The definite management of neutropenic enterocolitis is contrversial. but the prognosis is likely to be good with early diagnosis and proper management. We report one case of neutropenic enterocolitis in acute myelogenous leukemia with literature review.
Abdominal Pain ; Appendicitis ; Cecum ; Diagnosis, Differential ; Diarrhea ; Early Diagnosis ; Enterocolitis, Necrotizing ; Enterocolitis, Neutropenic* ; Fever ; Ileum ; Inflammation ; Intestinal Perforation ; Leukemia ; Leukemia, Myeloid, Acute* ; Lymphoma ; Nausea ; Neutropenia ; Prognosis ; Typhlitis ; Vomiting

Increasingly aggressive chemotherapy regimens, advances in transplantation technology, and the acquired immunodeficiency syndrome have resulted in a growing number of immunocompromised patients. Infections are a major cause of morbidity and mortality in this population. One of the most ominous complications is the development of typhlitis in this immunocompromised patients. Treatment of this process is controversial, and no consensus has emerged. We report a case of typhlitis who complicated agranulocytosis after exposure to drugs to treat "flu" like illness and recovered completely after two operations of appendectomy and ileocolectomy. Reviewing articles and this case, the favorable outcome seemed to be related to following three factors recognition of the acute surgical abdomen by abdominal CT scan, a prompt return of normal circulating white cells by the use of Granulocyte Colony Stimulating Factor and discontinuation of causative drugs, and an appropriately timed surgical intervention.
Abdomen ; Acquired Immunodeficiency Syndrome ; Agranulocytosis* ; Appendectomy ; Colony-Stimulating Factors ; Consensus ; Drug Therapy ; Granulocytes ; Immunocompromised Host ; Mortality ; Tomography, X-Ray Computed ; Typhlitis*

BACKGROUND: The long-term survival in patients with non-Hodgkin's lymphoma (NHL) after conventional chemotherapy is about 35% and the rest of the patients tend to have relapse. So, in relapsed or refractory NHL, the outcome of patients undergoing high-dose chemotherapy and autologous peripheral stem cell transplantation (APBSCT) was evaluated, and the main prognostic factors were determined. METHODS: 17 patients with relapsed or resistant NHL (5 complete response group, 7 partial response group, 4 primary refractory group, 1 resistant relapse) underwent BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy and APBSCT between July 1997 and February 1999. RESULTS: The median follow-up duration was 17 months (range: 4-47). The response rate was 58.3% (complete response 33.3%, partial response 25.0%) in 12 patients in whom complete response group was not included. The 2-year, 3-year overall response rate were 41.2%, 27.5%, respectively. And 2-year progression free survival was 35.3%. The disease status before high-dose chemotherapy was the only significant prognostic factor in determining overall survival (univariate p=.024, multivariate p=.059) and progression free survival (univariate p=.013, multivariate p=.026). Patients with complete response to salvage regimen had better overall survival (p=.021) and progression free survival (p=.008) than patients with refractory response. WBC (> or = 1,000/uL) was recovered at the median 11 days (range; 8-24), and platelet (> or = 50,000/uL) was recovered at the median 18 days (range; 9-44). There was no treatment-related death and no grade 3 and 4 toxicity. Neutropenic infection was in 4 patients (1 Herpes zoster, 1 typhlitis, 1 perianal infection, 1 otitis externa). CONCLUSION: The pre-transplant disease status was the main prognostic factor. Patients with complete response to salvage regimen had the significant benefit in survival from high-dose chemotherapy and APBSCT, but patients with refractory or resistant relapsed NHL did not have any significant benefit.
Blood Platelets ; Cytarabine ; Disease-Free Survival ; Drug Therapy ; Etoposide ; Follow-Up Studies ; Herpes Zoster ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Otitis ; Peripheral Blood Stem Cell Transplantation* ; Recurrence ; Typhlitis

Typhlitis is a necrotizing colitis that usually occurs in neutropenic patients and develops most often in patients with hematologic malignancies such as leukemia and lymphoma. Typhlitis may proceed to bowel perforation, peritonitis and sepsis, which requires immediate treatment. Irinotecan is a semisynthetic analogue of the natural alkaloid camptothecin which prevents DNA from unwinding by inhibition of topoisomerase I. It is mainly used in colon cancer and small cell lung carcinoma (SCLC), of which the most common adverse effects are gastrointestinal toxicities. To the best of our knowledge, no case of typhlitis after chemotherapy with a standard dose of irinotecan in a solid tumor has been reported in the literature. We, herein, report the first case of typhlitis developed after chemotherapy combining irinotecan and cisplatin in a patient with SCLC.
Camptothecin ; Cisplatin ; Colitis ; Colonic Neoplasms ; DNA ; DNA Topoisomerases, Type I ; Hematologic Neoplasms ; Humans ; Leukemia ; Lymphoma ; Peritonitis ; Sepsis ; Small Cell Lung Carcinoma ; Typhlitis