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Int J Colorectal Dis 2019 Oct 11;34(10):1815-1818. Epub 2019 Sep 11.

Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Introduction: Intussusception, which is common in pediatric patients but rare in adults with leukemia, usually presents with an intralumenal lesion as a lead point in adults.

Case Report: We herein report the case of a 38-year-old female who developed right lower quadrant abdominal pain and fever on day 16 of chemotherapy. Abdominal computed tomography showed ileocecal intussusception. Read More

Radiol Med 2019 Dec 13;124(12):1185-1198. Epub 2019 Jul 13.

Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy.

Clostridium difficile infection (CDI) is a severe and potentially deadly infectious colitis whose incidence is dramatically increasing in the last decades, with more virulent strains. CDI should be suspected in case of unexplained diarrhea and abdominal pain in patients with a recent history of antibiotic use and healthcare exposures; diagnosis is based on a combination of clinical and laboratory findings with demonstration of C. difficile toxins by stool test. Read More

J Ultrasound 2019 Mar 27;22(1):103-106. Epub 2018 Oct 27.

Department of Radiology-Ospedale del Mare-ASL NA1 Centro-Napoli, Naples, Italy.

Purpose: Typhlitis, also known as neutropenic colitis, is a rare inflammatory condition and a potentially life-threatening disease process that typically involves the cecum. Delay in diagnosis may lead to a fatal prognosis with a death rate of 21-48%. Ultrasound evaluation of right lower quadrant may lead to an accurate and rapid diagnosis. Read More

J Med Case Rep 2018 Aug 16;12(1):221. Epub 2018 Aug 16.

Department of Colorectal Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.

Background: Paclitaxel is a chemotherapy drug commonly used in the management of ovarian cancer. Colonic perforation is an extremely rare complication of paclitaxel administration with few case reports in the medical literature. We report a case of a patient with advanced ovarian cancer who had a rectal perforation following administration of paclitaxel. Read More

Leuk Res 2018 05 8;68:48-50. Epub 2018 Mar 8.

Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Background: The current standard of care for the treatment of patients with newly diagnosed acute myeloid leukemia (AML) is an anthracycline plus cytarabine. Both anthracyclines and cytarabine have been associated with the development of typhlitis, a serious adverse event characterized by inflammation of the bowel wall in patients with profound neutropenia, diagnosed by abdominal CT imaging and clinical symptoms. Given the paucity of available data, the aim of our study was to determine the incidence of typhlitis among AML patients receiving induction chemotherapy with idarubicin 12 mg/m (IDA), daunorubicin 60 mg/m (DNA60), or daunorubicin 90 mg/m (DNA90). Read More

J Gastroenterol Hepatol 2018 Apr;33(4):769

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Comp Med 2017 Dec;67(6):524-528

Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia.

An adult feline blood donor, group-housed in a closed colony with other blood donor cats in a laboratory animal facility, developed anorexia, abdominal pain, an abdominal mass effect, and hemorrhagic diarrhea. Ultimately Salmonella infection was diagnosed. The index cat and 2 additional cats in the closed colony had clinical signs consistent with Salmonella and yielded Salmonella serotype 4,12:i:- in fecal cultures. Read More

Expert Rev Hematol 2017 Feb 23;10(2):169-174. Epub 2017 Jan 23.

a Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil.

Introduction: Typhlitis is an abdominal complication of cancer chemotherapy, affecting mostly patients receiving intensive chemotherapeutic regimens with high potential to induce mucosal damage, such as patients with acute leukemia. Despite being relatively frequent, there are no randomized trials or high-quality cohort studies addressing important aspects of the diagnosis and management of the disease. Areas covered: In this review we discuss the gaps in the literature, acknowledging that the evidences for recommendations regarding the management of typhlitis are mostly expert opinion. Read More

J Feline Med Surg 2017 02 25;19(2):94-104. Epub 2016 Sep 25.

2 Department of Internal Medicine, University Paris-Est Créteil, National Veterinary School of Alfort, Maisons-Alfort, France.

Objectives This study aimed to describe the ultrasonographic, endoscopic and histological characteristics of the caecum and ileocaecocolic junction in cats suffering from chronic clinical signs compatible with caecocolic disease. Methods Cats presenting with clinical signs suggestive of a caecocolic disease were prospectively recruited. All cats underwent an ultrasonographic examination of the caecum, ileum, colon, ileocolic lymph nodes and local mesenteric fat, in addition to comprehensive abdominal ultrasonography. Read More

Lancet Infect Dis 2016 05 18;16(5):618. Epub 2016 Apr 18.

Department of Haematology, St George's Hospital, London, UK.

Praxis (Bern 1994) 2015 Dec;104(25):1414-6

1 Institut für Sonographie, Uster.

Radiol Clin North Am 2015 Nov 12;53(6):1255-71. Epub 2015 Aug 12.

Section of Abdominal Imaging, Imaging Institute, Digestive Disease Institute and Cancer Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, L10, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address:

Infectious and inflammatory enterocolitides can present with an acute abdomen. The most common entities are ulcerative colitis, Crohn disease, and Clostridium difficile colitis. This article reviews the clinical and imaging findings of patients who present acutely with infectious and inflammatory enterocolitides. Read More

Chirurg 2014 Nov;85(11):1010-1

J Patient Saf 2014 Sep;10(3):154-8

From the Department of Emergency Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio.

Study Objectives: The American College of Radiology lists oral contrast as an institution-specific option in the evaluation of right lower quadrant pain. Previous literature indicates that an accurate assessment for appendicitis can be made by CT using IV contrast alone, with significant time savings from withholding oral contrast. Before 2010, the protocol for CT use in the evaluation of possible appendicitis or undifferentiated abdominal pain routinely included oral contrast. Read More

J Med Primatol 2013 Dec 12;42(6):336-42. Epub 2013 Aug 12.

Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil.

Background: The acute abdomen is any abdominal disorder resulting in pain, shock, or sepsis. Although it has a multifactorial etiology, the primary cause is gastrointestinal tract pathology. The aim of this study was to assess the contribution of abdominal ultrasound as a complementary diagnostic tool in non-human primates with an acute abdomen. Read More

J Pediatr Hematol Oncol 2013 Oct;35(7):514-7

Departments of Pediatrics and Diagnostic Imaging, and Program in Child Health Evaluative Sciences, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.

This retrospective chart review describes pediatric patients with acute lymphoblastic leukemia or acute myeloid leukemia diagnosed between January 1999 and January 2008, who were identified with enteritis, typhlitis, or colitis. Among the acute leukemia patients, 33/449 (7.3%) with acute lymphoblastic leukemia and 13/89 (14. Read More

BMJ Case Rep 2013 Apr 17;2013. Epub 2013 Apr 17.

Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.

Typhlitis or neutropenic enterocolitis (NEC) is a life-threatening condition that occurs in neutropenic patients. Early recognition is crucial owing to high death rate. We present a case of a 54-year-old man, diagnosed with non-Hodgkin lymphoma who received a first cycle of rituximab, cyclophosphamide, hydroxydaunorubicin (doxorubicin), oncovin (vincristine), prednisolone (R-CHOP) chemotherapy 10 days prior presenting. Read More

Med Princ Pract 2012 20;21(1):36-9. Epub 2011 Oct 20.

Department of Pediatric Hematology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey.

Objective: To review our experience with typhlitis among children treated for acute leukemia.

Material And Methods: The medical records of children with acute leukemia and typhlitis between 2006 and 2009 were reviewed for demographics and symptoms, and for microbiological and imaging findings.

Results: In the 75 children with acute leukemia--54 with acute lymphoblastic leukemia (ALL) and 21 with acute myeloid leukemia (AML)--there were 10 episodes of typhlitis (4. Read More

Acta Paediatr 2012 Mar 14;101(3):308-12. Epub 2011 Oct 14.

Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.

Aim: To describe the symptoms, clinical management and short-term outcome in a series of paediatric oncology patients with severe typhlitis following conservative treatment.

Methods: Twelve episodes of severe typhlitis in 11 children with cancer treated at the paediatric oncology ward at Queen Silvias Children's Hospital between 1995 and 2006 were analysed retrospectively. Data on symptoms, radiological findings, laboratory status and treatment as well as outcome were collected and analysed. Read More

Pediatr Blood Cancer 2011 Oct 24;57(4):620-4. Epub 2011 Jan 24.

Children's Hospital and Research Center, Oakland, California 94609, USA.

Background: Prolonged febrile neutropenia (FN) remains a common problem in pediatric oncology and often leads to empiric computed tomography (CT) of the sinuses, chest, abdomen, and pelvis. Little evidence is available as to the diagnostic utility of CT in this setting.

Procedure: We performed a retrospective review of all oncology patients admitted to the hospital from January 2004 through December 2008 for FN who had daily fevers with neutropenia for 4 or more consecutive days prompting CT evaluation. Read More

BMJ Case Rep 2011 Sep 13;2011. Epub 2011 Sep 13.

Department of General Surgery, University College Hospital, London, UK.

Rofo 2010 Dec 12;182(12):1076-81. Epub 2010 Nov 12.

Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität, Tübingen.

Purpose: This study investigates the features of neutropenic enterocolitis (NE) in adults.

Materials And Methods: Chart and radiology report reviews were used to identify neutropenic patients with hematological diseases undergoing chemotherapy, who had CT scans for the clarification of abdominal symptoms between October 2003 and October 2009. Patients with any cause for enteritis other than NE were excluded. Read More

Radiographics 2010 Nov;30(7):1843-56

Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Box 218, Hills Rd, Cambridge, CB2 0QQ, England.

Gynecologic malignancies account for 10%-15% of all malignancies in females. A variety of oncologic options are available depending on organ of origin, histologic diagnosis, and disease grade and stage. Gynecologic malignancies are usually treated with surgery, chemotherapy, or radiation therapy. Read More

Eur J Radiol 2011 Mar 22;77(3):478-82. Epub 2009 Sep 22.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.

Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients.

Materials And Methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Read More

Emerg Med Clin North Am 2009 Aug;27(3):415-22

Department of Emergency Medicine, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR 97239, USA.

Neutropenic enterocolitis, also known as typhlitis or ileocecal syndrome, is a rare but important complication of neutropenia associated with malignancy. It occurs as a result of chemotherapeutic damage to the intestinal mucosa in the context of an absolute neutropenia, and can rapidly progress to intestinal perforation, multisystem organ failure, and sepsis. Presenting signs and symptoms may include fever, abdominal pain, nausea, vomiting, and diarrhea. Read More

J Pediatr Hematol Oncol 2009 Sep;31(9):630-4

Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Data on the risk factors for typhlitis in children with cancer are limited. The aim of the study was to define the epidemiologic and clinical features of typhlitis and to elucidate predisposing factors for its development. The medical records of pediatric patients with cancer who were diagnosed with typhlitis from 1995 to 2005 were reviewed for clinical, laboratory, and imaging findings. Read More

Clin Imaging 2009 Jul-Aug;33(4):253-60

Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.

Objective: To describe the imaging findings of abdominal complications caused by chemotherapy in pediatric cancer patients.

Subjects And Methods: Radiology studies of 243 patients treated in our Children Cancer Center were reviewed, 164 of whom had abdominal studies. Medical records of 54 patients with abnormal imaging findings were studied. Read More

Korean J Radiol 2008 Sep-Oct;9(5):449-57

Department of Radiology, St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Gastrointestinal system involvement is one of the principal complications seen in the recipients of hematopoietic stem cell transplantation (HSCT), and it is also a major cause of morbidity and death in these patients. The major gastrointestinal complications include typhlitis (neutropenic enterocolitis), pseudomembranous enterocolitis, viral enteritis, graft-versus-host disease, benign pneumatosis intestinalis, intestinal thrombotic microangiopathy, and post-transplantation lymphoproliferative disease. As these patients present with nonspecific abdominal symptoms, evaluation with using such imaging modalities as ultrasonography and CT is essential in order to assess the extent of gastrointestinal involvement and to diagnose these complications. Read More

J Thorac Oncol 2008 Oct;3(10):1188-90

Department of Internal Medicine, University of Maryland, Baltimore, Maryland, USA.

Pemetrexed is U.S. Food and Drug Administration-approved as a second line, single-agent treatment of recurrent metastatic non-small cell lung cancer. Read More

Med Sci Monit 2008 Aug;14(8):CS67-70

Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.

Background: Typhlitis is necrotizing inflammation of the cecum manifested by febrile right lower quadrant abdominal pain. All cases in literature have been described in immunocompromised such patients with hematological or solid malignancies, patients with neutropenia, patients with AIDS, and patients following immunosuppressive therapy for transplants.

Case Report: We report a case of a 72 year old non-immunocompromised patient who developed fever, nausea, vomiting and severe right lower quadrant pain. Read More

Clin Radiol 2008 Aug 14;63(8):895-900. Epub 2008 Apr 14.

Department of Radiology, Abdominal Imaging, NYU School of Medicine, NY 100016, USA.

Aim: To determine whether epiploic appendagitis occurs in the caecum.

Methods: From 2000-2006, 58 cases with classic computed tomography (CT) features of acute epiploic appendagitis (focal round or oval fat density immediately adjacent to the colon with surrounding oedema and stranding, with or without a central area of high attenuation) were identified from a radiology information system and available for review on the picture archiving and communication system (PACS). Cases were assigned to one of six colonic segments: rectum, sigmoid, descending colon, transverse colon, ascending colon, and caecum. Read More

Pediatr Hematol Oncol 2008 Mar;25(2):99-106

Department of Pediatric Hematology, Baskent University Faculty of Medicine, Ankara, Turkey.

Invasive fungal infection is one of the major causes of morbidity and mortality in immunocompromised patients. The occurrence of two invasive fungal infections in one patient at the same time is quite rare. Here the authors report on two adolescent patients with acute lymphoblastic leukemia who developed combined invasive pulmonary aspergillosis and hepatosplenic candidiasis during chemotherapy. Read More

J Pain Symptom Manage 2007 Nov;34(5):457-9

Rev Med Interne 2008 Mar 21;29(3):224-7. Epub 2007 Sep 21.

Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France.

Introduction: Typhlitis is a rare condition, characterized by necrotizing inflammation of the colon. It occurs mainly in neutropenic patients receiving chemotherapy for leukemia.

Exegesis: We report the case of a 64-year-old woman with T-cell lymphocytic leukaemia, who exhibited asymptomatic reactivation of cytomegalovirus infection and developed subsequently typhlitis. Read More

J Pediatr Hematol Oncol 2007 Oct;29(10):713-5

Department of Hematology/Oncology, University Children's Hospital, Belgrade, Serbia.

We present a patient with acute lymphoblastic leukemia and ataxia-telangiectasia (A-T). The 4-year-old girl is the first child of young nonconsanguineous parents of Serbian origin. Gait problems appearing in the second year of life were treated by physiotherapy. Read More

Emerg Med J 2007 Sep;24(9):670

Department of Radiology, Mackay Memorial Hospital, 92, Section 2, Chungshan North Road, Taipei, Taiwan.

Curr Infect Dis Rep 2007 Mar;9(2):116-20

Department of Gastrointestinal Medicine and Nutrition, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 436, Houston, TX 77030-4009, USA.

Neutropenic enterocolitis or typhlitis (from the Greek word typhlon, meaning cecum) is a clinical syndrome that occurs in the setting of disease or chemotherapy-induced neutropenia. The disease is characterized by an inflammatory process involving colon and/or small bowel, and it can result in ischemia, necrosis, bacteremia, hemorrhage, and perforation. The classic clinical features include fever and abdominal pain. Read More

Praxis (Bern 1994) 2007 Jan;96(4):99-100

Klinik und Poliklinik für Allgemeine, Innere Medizin, Inselpital Universitätsspital Bern.

Radiographics 2006 Sep-Oct;26(5):1373-90

Department of Radiology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France.

The ileocecal area is a relatively short segment of the gastrointestinal tract but may be affected by pathologic conditions that are either common throughout the gastrointestinal system or exclusive to this area. These conditions include benign and malignant tumors, inflammatory processes (appendicitis, diverticulitis, epiploic appendagitis, Crohn disease), infectious diseases, and miscellaneous conditions (cecal ischemia, typhlitis, cecal volvulus, duplication cyst). The various components of the ileocecal area (cecum, appendix, ileocecal valve, terminal ileum) are close to one another, so that these conditions may involve more than one anatomic structure, thereby creating a diagnostic dilemma. Read More

Pediatr Radiol 2006 Aug 7;36(8):890-1. Epub 2006 Jun 7.

Department of Radiological Sciences, Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Memphis, TN 38105-2794, USA.

Eur Radiol 2003 Dec 19;13 Suppl 6:L51-61. Epub 2002 Dec 19.

Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.

Cecal pathology is commonly encountered and may represent a diagnostic challenge in patients with either acute or chronic clinical presentations. Although appendicitis accounts for the majority of surgical conditions presenting with right lower quadrant pain, readers should be aware of the broad spectrum of cecal pathologies and characteristic CT findings, which can be useful in establishing the correct diagnosis. Read More

Int J Hematol 2005 Nov;82(4):319-23

Department of General Endocrine, Medical University of Gdańsk, Poland.

Necrotizing enterocolitis is a severe complication of high-dose chemotherapy in patients with hematopoietic malignancies. Some patients with severe mucositis may develop necrosis of the intestine, leading to typhlitis and perforation of the intestinal tract. The patients have few obvious symptoms; thus, early diagnosis and prompt treatment of intestinal necrosis or bowel perforation seem critical for a good overall treatment outcome. Read More

Pediatr Radiol 2006 Feb 29;36(2):155-7. Epub 2005 Oct 29.

Department of Radiology, Turgut Ozal Medical Centre, Inonu University School of Medicine, 44069 Malatya, Turkey.

Neutropenic enterocolitis (typhlitis) is an unusual acute complication of neutropenia, most often associated with leukaemia and lymphoma and characterized by segmental caecal and ascending colonic ulceration that may progress to necrosis, perforation, and septicaemia. We present a unique case of an 8-year-old girl with recently diagnosed infectious mononucleosis having findings consistent with typhlitis on abdominal CT. Read More

Cancer 2005 Jul;104(2):380-7

Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. beth.mccarville@st jude.org

Background: Typhlitis is increasingly recognized in children undergoing chemotherapy but is poorly characterized. The authors investigated the demographic, clinical, and imaging (ultrasonography and computed tomography [CT] scans) variables related to the diagnosis, risk, and outcome of typhlitis.

Methods: The authors reviewed the records of patients who had typhlitis (bowel wall thickness > or = 0. Read More

Am J Emerg Med 2004 Jul;22(4):276-9

Department of Emergency Medicine, Ton-Yen General Hospital, Taiwan, ROC.

The purpose of this study was to investigate the initial clinical features and subsequent outcomes in patients with adult leukemia with typhlitis or neutropenic enterocolitis. A retrospective review of 10 episodes of neutropenic enterocolitis in nine patients (age range, 21-71 years) with acute leukemia from March 1, 1990, through February 28, 2002, was conducted. In clinical presentations, fever appears in all patients, followed by abdominal pain or tenderness (90%) and diarrhea (60%), respectively. Read More

Pediatr Radiol 2004 Mar 14;34(3):245-9. Epub 2004 Jan 14.

Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105-2794, USA.

Background: The management of pediatric oncology patients with imaging evidence of appendiceal thickening is complex because they are generally poor surgical candidates and often have confounding clinical findings.

Objective: We sought to determine the significance of appendiceal thickening in pediatric oncology patients who also had typhlitis. Specifically, we evaluated the impact of this finding on the duration of typhlitis, its clinical management, and outcome. Read More

Turk J Pediatr 2003 Jul-Sep;45(3):248-50

Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey.

We report a case of acute lymphoblastic leukemia that was complicated by neutropenic enterocolitis (typhlitis) during the initial period of remission-induction chemotherapy. The patient's clinical symptoms resolved after aggressive treatment with intravenous fluids and electrolytes, nasogastric decompression, bowel rest, total parenteral nutrition, broad-spectrum antibiotics, and granulocyte colony-stimulating factor. Netropenic enterocolitis should always be considered in neutropenic leukemic children with the triad of fever, vomiting, and abdominal pain. Read More

Rev Esp Enferm Dig 2003 Jan;95(1):30-4, 35-9

Service of General Surgery and digestive II, Hospital Universitario La Fe, Valencia, Spain.

Introduction: Acute typhlitis is usually associated with severe immunosuppressive conditions. Initially described as closely associated with infantile myeloid leukaemia, its incidence increased along the last decade.

Design: retrospective review. Read More

Abdom Imaging 2002 Sep-Oct;27(5):600-2

Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer 52621, Israel.

Typhlitis is a life-threatening necrotizing process of the cecum associated with leukemia patients who have undergone chemotherapy. We present a rare complication of typhlitis in a boy with leukemia, in whom a right psoas abscess developed secondary to the inflammatory process of the cecum, with an emphasis on the computed tomographic findings of this severe and potentially life-threatening complication. Typhlitis should be added to conditions of the gastrointestinal tract that cause a psoas abscess such as Crohn's disease, diverticulitis, appendicitis, colorectal carcinoma, and appendiceal tumor. Read More

J Pediatr Surg 2002 Aug;37(8):1151-5

Department of Pediatric Surgery, DeVos Children's Hospital, Grand Rapids, MI, USA.

Background/purpose: The optimal management for typhlitis in pediatric oncology patients has not always been clear from the medical literature. Trends have varied between operative and nonoperative approaches. The aim of this study was to review the successful nonoperative management of these patients at our institution over the last decade to further clarify management guidelines for this difficult problem. Read More