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Proximal small bowel infarction associated with portal venous gas

B Dixon1, W Kelly

  • 1Intensive Care Unit, St Vincent's Hospital, Melbourne, VIC Australia.

Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
|April 11, 2006
PubMed

Insights

Clostridium perfringens can cause severe conditions like gas gangrene and food poisoning. This case highlights a fatal instance of enteritis necroticans in a leukemia patient, emphasizing the need for prompt surgical intervention and antibiotics.

Area of Science:

  • Medical Microbiology
  • Gastroenterology
  • Hematology

Background:

  • Clostridium perfringens is an anaerobic bacterium known to cause various diseases, including myonecrosis (gas gangrene), acute food poisoning, and necrotic enteritis (enteritis necroticans).
  • Enteritis necroticans is a severe intestinal condition characterized by necrosis of the small intestine, often associated with C. perfringens infection.

Purpose of the Study:

  • To report a rare case of enteritis necroticans in an adult patient with acute myeloid leukemia.
  • To discuss the clinical presentation, diagnostic findings, and management challenges of this severe gastrointestinal condition.

Main Methods:

  • Case report detailing a 33-year-old male with acute myeloid leukemia presenting with symptoms of enteritis necroticans.
  • Review of clinical presentation, laboratory findings (pancytopenia), and imaging results (portal venous gas).

Main Results:

  • The patient presented with an acute abdomen, diarrhea, and pancytopenia.
  • Extensive gas accumulation was observed in the intrahepatic and extrahepatic portal veins, indicative of severe intestinal compromise.
  • Despite intensive resuscitation, the patient experienced a fatal outcome shortly after ICU admission.

Conclusions:

  • Enteritis necroticans is a critical surgical emergency requiring prompt removal of necrotic bowel.
  • Standard treatment involves intravenous antibiotics such as penicillin, metronidazole, or clindamycin.
  • While antibiotics can reduce toxin production, beta-toxoid administration is not beneficial in established disease.

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