Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Oct 15, 2019; 10(3): 36-41
Published online Oct 15, 2019. doi: 10.4291/wjgp.v10.i3.36
Neutropenic enterocolitis: A clinico-pathological review
Rong Xia, Xuchen Zhang
Rong Xia, Department of Pathology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States
Xuchen Zhang, Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, United States
Author contributions: Xia R reviewed the literature and drafted the manuscript; Zhang X provided overall intellectual input, reviewed the literature, acquired the histological images, and edited the final version of the manuscript; all authors approved the final version to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xuchen Zhang, MD, PhD, Associate Professor, Department of Pathology, Yale University School of Medicine, 310 Cedar Street, PO Box 208023, New Haven, CT 06510, United States. xuchen.zhang@yale.edu
Telephone: +1-203-7856010 Fax: +1-203-7372922
Received: June 6, 2019
Peer-review started: July 12, 2019
First decision: August 30, 2019
Revised: September 6, 2019
Accepted: September 22, 2019
Article in press: September 22, 2019
Published online: October 15, 2019
Processing time: 133 Days and 8.9 Hours
Abstract

Neutropenic enterocolitis (NE) is a predominantly cecum-based disease with high mortality seen in patients post chemotherapy. The pathogenesis of NE is poorly understood and probably multifactorial involving mucosal injury, neutropenia, and impaired host defense to intestinal organisms. The clinical presentation is characterized as ileocolonic inflammation and bowel wall thickening in patients with neutropenia, fever, and abdominal pain. The pathological features of NE include patchy necrosis, hemorrhage, ulcer, edema, perforation, infiltrating organisms, and characteristically, depletion of inflammatory cells (neutrophils). NE should always be considered as a possible diagnosis in immunosuppressed patients, especially those receiving chemotherapy. High clinical and histological diagnostic discordance rate exists. High index of clinical suspicion and prompt appropriate personalized management are essential to achieve a lower mortality rate.

Keywords: Neutropenic enterocolitis; Typhlitis; Chemotherapy; Neutropenia

Core tip: Neutropenic enterocolitis (NE) is a predominantly cecum-based disease with high mortality seen in patients post chemotherapy. The pathogenesis of NE is still poorly understood. The clinical presentation is characterized as ileocolonic inflammation and bowel wall thickening in patients with neutropenia, fever, and abdominal pain. The pathological features of NE include patchy necrosis, hemorrhage, ulcer, edema, perforation, infiltrating organisms, and characteristically, depletion of inflammatory cells (neutrophils). High clinical and histological diagnostic discordance rate exists. High index of clinical suspicion and timely diagnosis are critical for patient appropriate treatment and improvement of survival.