Tifilita (blindness)

Tifilita (blindness) Tifilita is inflammation of cecum. The term has been associated for ileocaecal syndrome primadata in 1960 to describe swelling and / or necrosis of cecum, appendix and / or ileum in patients with leukemia. Secondary tifilita was related with aplastic anemia, lymphoma, AIDS and kidney transplant immunosuppression therapy for secondary neoplasms.
Tifilita was discovered in 10% of leukemic children who died during chemotherapy. The average mortality is 40-50% and is attributed to the CECA perforation, intestinal necrosis and sepsis. Disease prevalence is equal between the sexes. Tifilita occurs in adults as well as children.
Pathogenesis and causes.
Maximum normal colonic wall thickness is 3 mm CT. When the colon is distended with stool, fluid, or contrast, normal colonic wall is almost imperceptible. Fat pericolonica must demonstrate homogeneous attenuation. Tifilita is usually limited to the cecum, appendix and terminal ileum, however, may cause pancolita extending to distal cecum.
Tifilita pathology is inflammation and / or necrosis of cecum, apendicelu and / or ileum. Tifilitei etiology is unknown but its pathogenesis is multifactorial. Profound neutropenia as neutrophil count total 1000/μL predisposing factor appears universal. Mucosa damage by cytotoxic agents play an important role in tifilita observed during chemotherapy. Caecal distention in tifilita intake may prevent blood leading to mucosal ischemia and ulceration. The infection may be involved in particular with cytomegalovirus. Transmural penetration leads to bacterial invasion and finally to perforation. Necrosis of mucosa and submucosa may cause intramural hemorrhage. Neoplastic infiltration may be involved in some patients.
Signs and symptoms.
Maximum normal colonic wall thickness is 3 mm at computed tomography. When the colon is distended with stool, fluid or contrast material, normal colonic wall is almost imperceptible. Pericolonica demonstrates homogeneous fat attenuation. Tifilita is generally limited to the cecum, appendix and terminal ileum, however, may cause pancolita extending distal cecum.
Typical clinical presentation, the evolution and severity vary widely, include the following: -Watery diarrhea or blood, fever, nausea, vomiting -Localized abdominal pain right lower abdominal quadrant Secondary shock or sepsis-colonic perforation.
Physical examination includes the following: -Abdominal distension, absent bowel sound -Timpanism, tenderness -Occasionally a palpable mass, and diffuse tenderness of rebaund colony suggesting perforation, peritonitis.
Diagnosis.
Imaging studies. Simple abdominal radiograph is nonspecific but may show a similar density of fluid mass in left lower abdominal quadrant, adjacent upper intestinal distension loops, free intraperitoneal air and pneumomatoza. Transit barytic tifilita colonoscopy are contraindicated because they risk perforation.
Computer tomography demonstrated attenuated colon wall thickening and occasionally eccentric caecal distension. High attenuation of colonic wall thickening may represent hemorrhage. Pericolonica inflammation of mesenteric fat is common. Computer tomography identified complications, including pneumomatoza coli, pneumoperitoneum, fluidic colactiile pericolonice, abscesses. These complications may require emergency surgery.
Ultrasonography in tifilita includes peristalticda absence or low abdominal right lower quadrant bowel, thickened wall hiperechogen hiperechogena thickened lining. Doppler study showed hipervascularizarea mucosa and intestinal wall.
Treatment.
Tifilita patients are very ill and have high mortality rate. Medical treatment is conservative while waiting for the recovery of granulocytes. At diagnosis the patient should receive broad-spectrum antibiotics. In some cases patients are found positive blood cultures for gram-negative anaerobic bacteria. It can be bone marrow-stimulating factor There is reporting on effective therapy to vancomycin antipersistaltici agents are avoided. Recurrence is rare and most patients recover.
Successful surgical therapy in patients unresponsive to drug therapy. Proposed criteria for surgery include: -Persistent gastrointestinal bleeding after resolution of neutropenia and thrombocytopenia and correction of coagulation abnormalities Peritoneal perforation-free record -Clinical deterioration requiring support with vasopersoare or large volumes of fluid, suggesting uncontrolled sepsis Intraperitoneal process-development of symptoms in the absence of neutropenia which normally require surgery.