Definition, Causes, Diagnosis And Treatment Of Caecal Inflammation, Also Called Cecitis, Enterotyphlitis Or Enterocolitis
Typhlitis was first reported in the 1970s in children undergoing chemotherapy for leukaemia. Over the last few years, there is increasing recognition of this condition and repeatedly well documented to occur in both children and adults and in those with other forms of cancer who are on chemotherapy.
Some 30 years ago, a diagnosis of this condition was thought to be terminal. Thankfully, with early recognition, treatment is now possible. But what is enterocolitis or typhlitis?
Our large intestine or bowel starts as a big oblong pouch called the caecum (or cecum if you are American), into which the small intestines empties. On the blind end of the caecum is the appendix. The caecum continues upward as the first part of the colon referred to as the ascending colon on the right lower abdomen. It continues upwards towards the right upper abdomen, where it curves towards the left just under the right breast area into the part of the large intestine called the transverse colon. This then again, curves downwards under the left breast area as the descending colon, and continues as the sigmoid colon and into the pelvis, continuing into the rectum and anus.
Inflammation of that part of the large intestines called the caecum is called cecitis or caecitis, also referred to as typhlitis. The inflammation could spread to include part of the adjoining small intestines (that is why it is sometimes referred to as entero (small intestine) colitis (colon inflammation) or enterocolitis.
It is a common cause of right lower abdominal pain, loose stools and low grade fever in patients on intensive chemotherapy, or in those with low immunity and low white blood cell count or certain types of infections.
The exact cause of typhlitis is unknown. It is however believed by medical investigators to be due to severe inflammation and breakdown in wall of the lumen of the cecum and surrounding intestines, by very intense level of chemotherapy, or from certain infections.
It is a condition more commonly seen in children on chemotherapy for acute leukaemia and increasingly in adults with other forms of cancer.
It is also believed that the steroids used along side chemotherapy in the treatment of such cancers could contribute to the emergence of this condition.
This condition is not found with the use of all forms of chemotherapy medications. It is believed that this inflammation of the caecum is more common in those who are on chemotherapy treatment with the following medications:
Apart from chemotherapy, studies have also revealed that those with certain types of infections like fungal infection, or yersina infection and who are immuno-compromised with conditions like HIV / AIDs or other forms of immune problems could develop caecitis.
If you are on chemotherapy and have a combination of any of the above symptoms, it is likely that you are suffering with cecitis or typhlitis. Seek immediate medical attention. This condition could be life threatening if not diagnosed and treated in time.
Enterotyphlitis or neutropaenic enterocolitis or caecitis is a condition believed to occur more commonly in those having chemotherapy or who just finished chemotherapy within the last two weeks. It is very rare otherwise. The following represents how common this condition is:
To make a diagnosis of typhlitis, your doctor will need to get a full story of the symptoms you have, will need to examine you and then do some blood tests and scans.
The story your doctor will want to know include:
The examination will be thorough. Your doctor will want to check your temperature, take a look at your eyes to see if you are pale or jaundiced, and have your pulse, blood pressure and chest checked. The examination will then be focused on your abdomen. Your doctor will want to feel your abdomen to find out where hurts most, and then listen for the sounds of your bowels. It may be necessary to check your back passage (rectal examination) and your groin too.
The most important of the blood tests you need to do is your full blood count (complete blood count in North America), to check your white blood cells as well as your haemoglobin and platelet levels. Other blood tests are routinely done to check your liver, kidney, and inflammatory markers (CRP and ESR).
If your neutrophil - white blood cell count is very low, in the presence of a right lower abdominal pain and you are on chemotherapy, you have cecitis until proven otherwise!
The diagnosis can then be confirmed with a CT scan.
The CT scan typically shows a caecum with thickened wall with free fair trapped between the cecum and coils of bowels, all cramped together.
Where CT does not exist, the diagnosis of typhlitis can also be made on ultrasound scan along side a very typical story.
Once diagnosis of caecitis is made, the treatment is often straight forward, and it generally involve:
There is no way to determine who will suffer with typhlitis or not. The best prevention is to be very alert to this condition if you are on chemotherapy. Should you have any pain on your lower right abdomen not settling after a day, and it is best to check with your doctor. At least if you have developed inflammation of the caecum, it would be picked up in time and treatment out come will be quicker and better.
Many experts believe that if you are on chemotherapy, there are things you could do to help prevent or reduce the effects of chemotherapy. Various herbs and supplements have been advocated.
Are you or your loved one on Chemotherapy? Suffering with a lower abdominal pain? Does the symptoms seem to fit those of typhlitis? Or have you suffered with a confirmed case of typhlitis or neutropaenic enterocolitis in the past? Share your thoughts here please.
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Last Updated: 12.12.12
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