# Neutropenic enterocolitis (typhlitis): imaging, cultures, antibiotics and conservative care

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

## TL;DR

During intensive chemotherapy, when white cells are very low, the bowel wall can become inflamed and infected. Fever with tummy pain, diarrhoea or bloating is an emergency: ring your treatment helpline at once. In hospital it is confirmed with an ultrasound or CT scan and treated with strong antibiotics through a drip, fluids, pain relief and resting the bowel, with surgeons asked to see you.

## Summary

Neutropenic enterocolitis complicates intensive chemotherapy, above all for acute leukaemia; AGIHO cites a pooled incidence of 5.3% in hospitalised patients with haematological cancers, aplastic anaemia or high-dose chemotherapy, and mortality from under 20% to 82%. High-dose cytarabine with anthracyclines is the main risk factor. A 2025 cohort of 178 episodes found it in 13.8% of AML induction courses and 9.5% of autologous transplants (higher with 7+3 induction and BEAM conditioning) with lower 30-day mortality than earlier reports.

AGIHO 2017: proposed diagnostic criteria are fever, abdominal pain and bowel wall thickening over 4 mm across more than 30 mm on ultrasound or CT; a clinical definition (temperature 37.8 °C or more with abdominal pain and/or no bowel movement for 72 hours or more) identifies neutropenic patients at risk earlier. Imaging confirms it and excludes perforation; blood and stool cultures and a C. difficile toxin test are recommended; endoscopy is discouraged because of perforation risk. Conservative therapy (bland diet, hydration, pain control; BIII); piperacillin-tazobactam, imipenem-cilastatin or meropenem (BIII), continued until clinical signs and neutropenia resolve; no evidence on adding metronidazole or vancomycin (CIII); empirical antifungal therapy may be discussed (BIII); growth factors might be considered (BIII). Surgical consultation early; surgery reserved for severe cases such as perforation (BIII).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: typhlitis; NEC; neutropenic colitis; ileocaecal syndrome; chemotherapy-associated bowel syndrome
- Tags: protocol; acute-oncology; oncological-emergency; neutropenic-sepsis

## Connected records

- protocols: [Suspected febrile neutropenia (neutropenic sepsis): the first hour](https://onco.cc/protocols/febrile-neutropenia-first-hour/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/)
- drugs: [Cytarabine](https://onco.cc/drugs/cytarabine/), [Filgrastim (G-CSF)](https://onco.cc/drugs/filgrastim/)
- terms: [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Neutropenia](https://onco.cc/terms/neutropenia/)

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