ABSTRACT

Neutropenic enterocolitis is best defined as a clinical syndrome with features indistinguishable from other causes of bowel inflammation. Patients usually present with fever, abdominal pain, diarrhea, and have evidence of thickened bowel wall.  This potentially fatal complication is not uncommon in neutropenic children, whereas, in adults neutropenic enterocolitis is often seen in older patients with advanced cancer undergoing salvage chemotherapy for a hematologic malignancy. Patients with oro-intestinal mucosal damage following antineoplastic therapy are at an increased risk. The diagnosis is based on clinical features and evidence of diffuse or localized bowel wall thickening on CT scan; presence of air with in the bowel wall “pneumatosis intestinalis” indicates serious disease with an increased risk of perforation. Treatment is generally supportive with strict bowel rest, parenteral hydration and nutritional support, along with broad spectrum antimicrobials. Myeloid growth factors promote early recovery form neutropenia. Surgery is reserved for patients with perforation of bowel with complicated peritonitis. In this chapter a comprehensive discussion regarding Clostridium difficile (Cdiff) is presented with emphasis on risk factors, clinical presentation and antimicrobial therapy.