Circumferential wall thickening of the caecum and ascending colon (± terminal ileum) with pericolic stranding in a neutropenic patient on chemotherapy — reported with wall thickness and a direct search for pneumatosis and perforation.
Orient first
- Neutropenia after chemotherapy, especially in leukaemia; mortality is high.
- Wall thickness over 10 mm is associated with worse outcome (verify local thresholds).
- Differential: C. difficile colitis (pancolitis), CMV colitis, ischaemia, GVHD.
Acquire the study
- CT abdomen and pelvis with intravenous contrast in portal venous phase.
The manoeuvre
- Caecum and ascending colon: wall thickness in mm, low-attenuation submucosal oedema.
- Pericolic fat stranding and fluid.
- Pneumatosis, portal venous gas, free gas on lung window.
- Distribution beyond the right colon (alternative diagnoses).
What confirms it
- Right colonic wall thickening in a neutropenic febrile patient with abdominal pain.
What licenses you to exclude it
- A normal right colon wall makes neutropenic enterocolitis unlikely.
The classic misread
- Calling it appendicitis and sending a neutropenic patient to surgery unnecessarily.
- Missing pneumatosis or perforation.