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Potentially life-threatening emergency
Neutropenic enterocolitis
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Neutropenic enterocolitis

Contributors: Michael W. Winter MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


Neutropenic enterocolitis refers to a severe, potentially fatal necrosis of the colon or small bowel that occurs in an immunocompromised patient. The etiology is not clearly described but likely is triggered by impaired host immune response and underlying mucosal injury. Inflammation and necrosis occur most frequently in the cecum but can involve any area of the small bowel or colon.

Patients with leukemia undergoing cytotoxic chemotherapy are at highest risk for neutropenic enterocolitis. This was initially appreciated in pediatric patients but is seen in adults as well. Any patient with chemotherapy-induced neutropenia is at an increased risk for neutropenic enterocolitis.

Neutropenic enterocolitis commonly presents with right lower quadrant abdominal pain, diarrhea, and fever with underlying neutropenia or immune compromise. Patients can develop severe sepsis with end-organ damage and bowel perforation with progressive neutropenic enterocolitis. Early recognition and treatment of sepsis with intravenous antibiotics and volume resuscitation, along with surgical intervention if necessary, are the hallmarks of treatment that can improve mortality. If untreated, neutropenic enterocolitis can be fatal.


K52.9 – Noninfective gastroenteritis and colitis, unspecified

240358005 – Neutropaenic enterocolitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acute appendicitis
  • Appendiceal abscess
  • Acute graft-versus-host disease
  • Viral gastroenteritis, bacterial, or parasitic gastroenteritis (including Cytomegalovirus infection, Norovirus infection, Clostridioides difficile colitis)
  • Ischemic colitis
  • Colonic pseudo-obstruction
  • Acute mesenteric ischemia
  • Acute viral hepatitis
  • Choledocholithiasis
  • Ascending Cholangitis
  • Acute Acute cholecystitis / Acalculous cholecystitis
  • Acute pancreatitis
  • Bowel obstruction (Small bowel obstruction or Large bowel obstruction intestine)
  • Diverticulitis
  • Inflammatory bowel disease (Crohn disease or Ulcerative colitis)

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:03/27/2018
Last Updated:11/01/2022
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Neutropenic enterocolitis
A medical illustration showing key findings of Neutropenic enterocolitis : Diarrhea, Fever, Nausea/vomiting, Abdominal distension, Reaction 6 to 30 days after drug, Hematochezia, RLQ pain, WBC decreased
Imaging Studies image of Neutropenic enterocolitis - imageId=6110975. Click to open in gallery.
Copyright © 2024 VisualDx®. All rights reserved.