# Neutropenic enterocolitis (typhlitis)

Source: https://onco.cc/terms/neutropenic-enterocolitis-typhlitis/  
OnCo record `neutropenic-enterocolitis-typhlitis` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

An inflammation and infection of the bowel wall, often near the start of the large bowel, in people whose white cell count is very low after chemotherapy. It causes fever, tummy pain and diarrhoea, and is treated in hospital with antibiotics, fluids and rest for the gut.

## Summary

The AGIHO/DGHO guideline (2017) calls neutropenic enterocolitis a common chemotherapy-associated complication, particularly in acute leukaemia, with a pooled incidence of 5.3% in hospitalised patients with haematological malignancies, aplastic anaemia or high-dose chemotherapy for solid tumours; high-dose cytarabine with anthracyclines is a major risk factor. Mucosal damage lets bacteria, viruses and fungi invade the bowel wall, Gram-negative Enterobacteriaceae being the commonest organisms in blood cultures. Proposed diagnostic criteria are fever, abdominal pain and bowel wall thickening of more than 4 mm over more than 30 mm on ultrasound or CT. Endoscopy is discouraged because of the risk of perforation, and conservative management (bland diet, hydration and pain relief) is preferred in most cases, with piperacillin-tazobactam, imipenem-cilastatin or meropenem recommended as antibiotics. In a 2026 cohort of 1,259 adults, 178 episodes occurred across 1,963 intensive courses, most during AML induction (13.8% of courses) and autologous transplant conditioning (9.5%), and 30-day mortality was lower than previously reported.

## Fields

- Kind: Term
- Last checked: 2026-11-11
- Also known as: Typhlitis; Neutropenic enterocolitis; NEC; Neutropenic colitis
- Tags: supportive-care-gaps-2026-11

## Sources

- Schmidt-Hieber et al., Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated guidelines of the AGIHO/DGHO (Ann Hematol 2018): https://europepmc.org/article/PMC/PMC5748412
- Epidemiology, risk factors and outcomes of neutropenic enterocolitis in onco-haematological patients according to chemotherapy regimen (Clin Infect Dis 2026): https://europepmc.org/article/MED/40112243

## Connected records

- cancers: [Acute myeloid leukaemia](https://onco.cc/cancers/aml/)
- drugs: [Cytarabine](https://onco.cc/drugs/cytarabine/), [Piperacillin with tazobactam](https://onco.cc/drugs/piperacillin-tazobactam/)
- terms: [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Neutropenia](https://onco.cc/terms/neutropenia/)

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