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Segmental enteritis: "enteritis necroticans". A clinicopathologic study

G Singh1, V Narang, A K Malik

  • 1Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Journal of Clinical Gastroenterology
|January 1, 1996
PubMed
Summary
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Acute segmental enteritis, or enteritis necroticans, is a severe intestinal condition. This study highlights its challenging diagnosis and high complication rates, emphasizing the need for prompt surgical intervention.

Area of Science:

  • Gastroenterology
  • Abdominal Surgery
  • Pathology

Background:

  • Acute segmental enteritis (enteritis necroticans) presents as nonocclusive intestinal ischemia without a clear cause.
  • It often requires emergency laparotomy, with preoperative diagnosis being infrequent.

Purpose of the Study:

  • To characterize the clinical presentation, surgical findings, and outcomes of patients with acute segmental enteritis.
  • To investigate the pathological and microbiological features of the condition.

Main Methods:

  • Retrospective review of 30 patients undergoing emergency laparotomy for acute abdominal symptoms over 5.5 years.
  • Analysis of surgical findings, including location and extent of intestinal damage.
  • Histopathological examination of resected bowel specimens and microbiological profiling.

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Main Results:

  • The jejunum was the most common site (63.3%) of necrotic patches, gangrene, perforation, and dusky lesions.
  • Twenty-eight patients required bowel resection; angiography showed normal mesenteric vasculature.
  • Microbiological studies did not isolate Clostridium welchii. Histology revealed mucosal ulceration, edema, inflammation, and necrosis of the muscularis propria with patent intramural vessels.
  • High rates of complications including wound-related (14), pulmonary (14), renal failure (8), and fecal fistulas (5) were observed.

Conclusions:

  • Acute segmental enteritis is a severe condition characterized by extensive intestinal necrosis, often requiring resection.
  • Despite normal vasculature and negative Clostridium welchii cultures, significant morbidity and mortality (23.3%) underscore the disease's severity and diagnostic challenges.