Differential Diagnosis: Neutropenic Colitis

Neutropenic colitis (typhlitis) mimicking appendicitis.

3 year old neutropenic male receiving chemotherapy for acute lymphocytic leukemia developed right sided abdominal pain, abdominal distention, and rectal bleeding. CT examination, shown below, was obtained to differentiate between right lower quadrant abscess related to appendicitis and typhlitis.

Intravenous contrast-enhanced CT image through the upper pelvis demonstrates marked circumferential thickening of the walls of the ascending colon (*) consistent with typhlitis. The appendix was not identifiable.
The patient responded to broad spectrum antibiotic therapy and was discharged home 13 days later.

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