• Necrotizing enterocolitis with predilection for cecum.
• Occurs in the immunosuppressed, especially when neutropenic (<500 PMNs)
• Typically a polymicrobial infection; gram positive cocci, gram negative rods, anaerobes, and/or fungal. 
• Classically, right lower quadrant pain but can present with diffuse abdominal pain and peritoneal signs.
• CT scan with IV and PO contrast is diagnostic (see below)
• Treatment:
  • Culture and begin broad spectrum antibiotics (cover anaerobes) and antifungals (if suspected) 
  • Aggressive resuscitation
  • Surgical consult for GI perforation or clinical deterioration
• High mortality (40-50%)

TIP: Suspect when abdominal pain presents 10-14 after chemotherapy (when PMNs are lowest).

References

Blijlevens NM, et al. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 2000 Jun;25(12):1269-78