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Intestinal obstruction in children due to segmental enteritis: experience in Chittagong, Bangladesh
Md Jafrul Hannan1, Md Mozammel Hoque
1Chattagram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh. boto_briksha@yahoo.com
Insights
Segmental enteritis in children presents as acute abdomen with obstruction symptoms but lacks a mechanical cause. Most cases improve with intraoperative management, avoiding extensive surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Abdominal Imaging
Background:
- Segmental enteritis, also known as acute segmental necrotizing enteritis, presents a diagnostic challenge in children with acute abdominal symptoms.
- Features include high fever, rectal bleeding, and signs of intestinal obstruction, often leading to surgery without a clear obstructing lesion.
Purpose of the Study:
- To report the first study from Bangladesh on acute segmental enteritis in children.
- To evaluate the clinical presentation, operative findings, and outcomes of managing this condition.
Main Methods:
- A prospective descriptive study of 24 consecutive pediatric cases managed between January 2004 and December 2009.
- Inclusion criteria: acute abdomen, radiographic signs of obstruction, and intraoperative findings of segmental small intestinal ischemia without definite obstruction.
Main Results:
- All patients had fever and leukocytosis; 15 had per-rectal bleeding. The jejunum was most commonly involved (17 cases).
- Operative findings included ischemic lesions (patches, dusky walls, gangrene) without mechanical obstruction. Two deaths (8.33%) occurred; two patients required reoperation for complications.
- Mean hospital stay was 10.63 days, with most patients recovering well after follow-up.
Conclusions:
- Segmental enteritis is an occasional cause of acute abdomen in Bangladeshi children, requiring surgical intervention.
- No mechanical obstructing lesion was identified in any case; conservative intraoperative measures were effective for most.
- The condition necessitates surgical exploration, but extensive resection or stoma creation is often avoidable.
Introduction:
Acute segmental enteritis is also known as acute segmental necrotizing enteritis, segmental obstructing acute jejunitis, and enteritis necroticans. Children presenting with high fever, P/R bleeding, prostration etc. along with features of intestinal obstruction are not uncommon. Many of these cases had to be operated upon revealing no definite obstructing lesion, except a segment of small gut with different magnitude of inflammation. The principal author encountered many of these cases in the same hospital and also in the previous working places. This study was thus undertaken and this is the first report from Bangladesh on segmental enteritis.
Materials And Methods:
From 1 January 2004 to 31 December 2009, 24 consecutive cases suffering from enteritis were managed. This prospective descriptive study evaluates the sex, age, presentations, physical findings, operative findings, hospital stay, outcome and complications. The inclusion criteria were an acute abdominal presentation, plain radiographic features of intestinal obstruction and intraoperative findings of segmental small intestinal involvement with ischemic lesions without definite obstruction.
Results:
Fever and leucocytosis were present in all, abdominal tenderness in 17 and per-rectal bleeding in 15 cases. Jejunum alone was involved in 17, both jejunum and ileum in 5 and ileum alone in 2 cases. Scattered dark patches over the intestinal wall was found in 16, circumferential dusky lesions in 4, perforation in one and frank gangrene in 3 cases. Bacteriology of the peritoneal fluid in 17 cases revealed mixed flora. Histopathology of the mesenteric lymph nodes in 11 cases showed non-specific hyperplasic changes. Histopathology of four resected gut walls showed inflammatory infiltrates. In 17 cases recovery was uneventful. Seven cases suffered different complications including two (8.33%) deaths. One with ileal stricture and another with fecal fistula required reoperation. Mean hospital stay was 10.63 ± 3.00 days. The surviving patients were followed up for at least 6 months and faring well.
Conclusions:
Segmental enteritis is occasionally encountered as a cause of acute abdomen in children of Bangladesh. Operative treatment is required and mechanical obstructing lesion was found in none of the cases. Majority of cases improve on intraoperative measures other than gut resections or creation of stoma.
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