diagnosis in neutropenic enterocolitis

 Q: Which of the following is the gold standard for diagnosis in neutropenic enterocolitis? (select one)

A) Computed tomography (CT) of the abdomen
B) Plain films of the abdomen (KUB)
C) Blood and stool cultures with C. difficile toxin assays 
D) Barium enema
E) Colonoscopy


Answer:  A

The objective of above question is to highlight the dangers of barium enema and coloscopy in the neutropenic enterocolitis, popularly known as 'typhlitis'. Barium enema and colonoscopy can cause perforations. Also with thrombocytopenia in the setting of post-chemotherapy, colonoscopy may induce bleeding.

Plain films may be helpful to see fluid level and are noninvasive. Similarly, cultures may guide the choice of antibiotics.


References: 

1. Wade DS, Nava HR, Douglass HO Jr. Neutropenic enterocolitis. Clinical diagnosis and treatment. Cancer 1992; 69:17. 

2.  Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology 2003; 226:668.