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Acute necrotizing colitis and obstruction.

C Teasdale, N J Mortensen

    The British Journal of Surgery
    |January 1, 1983
    PubMed
    Summary
    This summary is machine-generated.

    Acute necrotizing colitis, a rare complication of colonic obstruction, presents with shock but no perforation. Prompt total colectomy improves survival rates in affected patients.

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    Area of Science:

    • Gastroenterology
    • Surgical Pathology

    Background:

    • Acute necrotizing colitis is a rare but severe complication associated with colonic obstruction.
    • Understanding its pathophysiology is crucial for effective clinical management.

    Observation:

    • Six cases of acute necrotizing colitis secondary to colonic obstruction were observed over 20 months.
    • Patients presented with signs of obstruction and shock, but without bowel perforation.

    Findings:

    • Surgical exploration revealed mucosal necrosis to gangrene in the colon proximal to the obstruction.
    • Gram stains identified Gram-positive bacilli, suggestive of clostridia, invading the colonic mucosa and submucosa.
    • While defunctioning colostomy alone led to mortality, total colectomy resulted in survival for 4 out of 6 patients.

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    Implications:

    • Raised intraluminal pressure in colonic obstruction may lead to ischemic injury, facilitating anaerobic bacterial invasion.
    • Early surgical intervention, specifically total colectomy, appears critical for improving outcomes in acute necrotizing colitis.
    • Further research is needed to elucidate the exact causative agents and mechanisms of this condition.