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Angiographic and immunologic studies in acute necrotizing jejunoileitis
V V S S Chandrasekharam1, D N Srivastava, M Mathur
1The Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi.
Journal of Tropical Pediatrics
|May 23, 2002
Summary
Acute necrotizing jejunoileitis in children may stem from immune system overreactions. Elevated immunoglobulin E (IgE) and hypersensitivity reactions suggest an immunological basis for this severe small bowel condition.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Vascular Medicine
Background:
- Acute necrotizing jejunoileitis is a severe intestinal condition requiring surgical intervention.
- The etiology of jejunoileitis remains unclear, with limited understanding of underlying mechanisms.
Purpose of the Study:
- To investigate the potential etiological basis of acute necrotizing jejunoileitis.
- To explore the role of immunological factors in the pathogenesis of this condition.
Main Methods:
- Retrospective analysis of 18 cases of laparotomy-proven acute necrotizing jejunoileitis.
- Laboratory investigations, bacteriological studies, and superior mesenteric artery digital subtraction angiography.
- Histopathological examination of resected small bowel tissue, including assessment of immunoglobulin levels.
Main Results:
- Routine investigations and bacteriology did not identify a specific cause.
- Angiography revealed extensive neovascularization in affected bowel segments.
- Significantly elevated immunoglobulin E (IgE) levels were observed, alongside evidence of type I and type III hypersensitivity reactions in four patients.
Conclusions:
- The findings suggest an immunologically mediated process in acute necrotizing jejunoileitis.
- Intense vasculitis, potentially triggered by hypersensitivity reactions, leads to ischemic damage of the small bowel.
- Elevated IgE levels may serve as a biomarker for this condition.