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Tropical enterocolitis in children
1Department of Surgical Pediatrics, Bai Jerbai Wadia Hospital for Children, Parel, Bombay, India.
Insights
Tropical enterocolitis is a distinct condition presenting as acute abdomen, differing from neonatal necrotizing enterocolitis. Early diagnosis via laparoscopy aids conservative treatment, preventing extensive surgery for this bowel inflammation.
Area of Science:
- Gastroenterology
- Pathology
- Surgical Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a significant neonatal intestinal disease.
- Sporadic cases of enterocolitis occur in tropical regions, distinct from NEC.
Observation:
- Tropical enterocolitis presents as acute abdomen with symptoms like pain, vomiting, and diarrhea.
- This condition involves segmental inflammation of the jejunum, ileum, or colon, and occasionally the duodenum.
- Clinical presentation is less severe than neonatal NEC.
Findings:
- Laparoscopy is crucial for diagnosis, differentiating from perforation or gangrene.
- Pathology suggests a localized hyperimmune reaction with vasculitis, leading to bowel ischemia.
- Findings range from hemorrhages to mucosal ulceration and perforation.
Implications:
- Conservative management is often successful, especially with accurate laparoscopic diagnosis.
- Laparoscopy reduces the need for exploratory laparotomy.
- Understanding the pathogenesis of vasculitis is key for targeted therapies.
Abstract:
Besides classical necrotizing enterocolitis (in neonates), which is seen in India as elsewhere in the world, we observe sporadic cases of tropical enterocolitis, i.e. segmental jejunitis, ileitis or colitis and rarely duodenitis. This is a distinct clinico-pathological entity presenting as "acute abdomen", with pain, bilious vomiting, constipation or bloody diarrhoea. The clinical course is not as fulminating as neonatal necrotizing enterocolitis. Most cases are salvaged by conservative treatment especially after the confidence brought by laparoscopic vision of the abdomen, thus excluding perforation or gangrene of the bowel involved. Without laparoscopy, most of the cases end up in laparotomy. The pathology appears to be a kind of local hyperimmune reaction in the segment of bowel involved, ranging from punctate haemorrhages in the seromuscular layer of the bowel to a generalized red fiery look or perforation due to mucosal ulceration. Whatever the causative agent, the pathogenesis is of local vasculitis leading to ischemia and various patterns of disease.