Adult ischemic necrotizing enterocolitis

T Mitchell1, E Christie, Habib Syed

  • 1Gastroenterology Unit, Warrington General Hospital, Cheshire, UK.

Insights

A myocardial infarction patient experienced unexplained rectal bleeding, ultimately diagnosed postmortem as necrotizing enterocolitis (NEC) caused by aortic thrombosis and bowel ischemia.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Pathology

Background:

  • Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition often seen in neonates, but rare in adults.
  • Adult NEC can be challenging to diagnose due to non-specific symptoms and rarity.

Observation:

  • A 66-year-old male with posterior myocardial infarction presented with painless lower gastrointestinal bleeding.
  • Despite extensive investigations, the source of bleeding remained unidentified during his hospitalization.

Findings:

  • Postmortem examination revealed severe atherosclerosis and aortic thrombosis leading to bowel ischemia, perforations, and necrosis.
  • These findings confirmed a diagnosis of necrotizing enterocolitis (NEC) in the adult patient.
  • Key NEC pathogenesis factors include bowel ischemia and bacterial infection.

Implications:

  • This case highlights the importance of considering rare causes of lower gastrointestinal bleeding in adults, even with concurrent cardiac events.
  • Severe atherosclerosis and aortic thrombosis can precipitate bowel ischemia and NEC.
  • Prompt diagnosis and management, ranging from supportive care to surgery, are crucial for NEC outcomes.

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