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PubMed2006

Necrotising enterocolitis.

Necrotising enterocolitis is one of the most common gastrointestinal emergencies in newborn infants. Here we review the epidemiology, clinical presentation, and pathophysiology of the disease, as well as strategies for diagnosis, management, and prevention. Necrotising enterocolitis is one of the most devastating and unpredictable diseases affecting premature infants. Despite decades of research, its pathogenesis remains unclear; diagnosis can be difficult; and treatment is challenging. We will need to improve our understanding of intestinal defences in premature infants, dietary and bacterial factors, and genetic effects that could predispose infants to necrotising enterocolitis before we can develop new strategies for prevention and treatment.

Enterocolitis, Necrotizing↗
PubMed2000

Foaling-management practices associated with the occurrence of enterocolitis attributed to Clostridium perfringens infection in the equine neonate.

Enterocolitis associated with Clostridium perfringens (C. perfringens) infection in neonatal foals is often severe and has been associated with a high case-mortality risk. We designed a premises-based survey to evaluate the associations of regional foaling practices, premises environmental management, periparturient foal and brood-mare management, and periparturient brood-mare ration with the occurrence of neonatal enterocolitis attributed to C. perfringens infection. Potential risk factors individually associated with enterocolitis were breed type, housing type at foaling and in the first three days of life, ground/floor surface type at foaling and in the first three days of life, brood-mare ration before and after foaling, and the presence of livestock other than horses on the premises in the past. From the multivariable-logistic regression models, six variables were significantly associated with an increased risk of the outcome of interest (p<0.05): foals of the stock horse type, housing in a stall or drylot in the first three days of life, other livestock present on the premises in the past, foal born on dirt, sand or gravel surface, and low amounts of grass hay and grain fed post-partum. Low grain amounts fed pre-partum represented a decreased risk of the outcome of interest.

Animal Husbandry↗
PubMed2002

[Pseudotumoral enterocolic phlebitis of the cecum and rutoside. A case report].

INTRODUCTION: Enterocolic phlebitis is an entity characterized by ischemic injury of the gastrointestinal tract caused by thrombophlebitis of the mesenteric veins without arterial involvement or systemic disease. EXEGESIS: We report a case of enterocolic phlebitis in a 57-year-old female treated by rutoside, revealed by intestinal obstruction related to a pseudotumoral lesion of the caecum. CONCLUSION: This case adds to the four cases of enterocolic phlebitis under rutoside already reported in the literature, suggesting a possible involvement of this drug in this rare disease.

Cecal Diseases↗
PubMed1993

Clostridia-associated enterocolitis in adult horses and foals.

A review of the literature describing clostridia-associated enterocolitis is presented. The bacteria, their toxins, and possible factors that interact to contribute to the pathogenesis of enterocolitis are described. Clinical signs associated with clostridia-associated enterocolitis, methods of diagnosis, treatments, and preventive strategies are discussed.

Animals↗
PubMed2004

Radiological findings in two patients with cow's milk allergic enterocolitis.

Cow's milk allergic enterocolitis is a common paediatric gastrointestinal disease. However, radiological findings from contrast studies have rarely been reported. We report two Japanese neonate patients with cow's milk allergic enterocolitis with vomiting, bloody stool and unique findings on upper gastrointestinal contrast study. Upper gastrointestinal contrast study showed folds of the small intestine to be thickened, such as in spasm, or ribbon-like cords in both cases. There was also poor passage from the duodenum to the jejunum in one case. In addition, there were spastic findings on lower gastrointestinal contrast study in part of the large colon in one case. Clinicians, including paediatric surgeons, treating neonates with bloody stool and/or vomiting should thus be aware that unique findings on upper and lower gastrointestinal contrast studies may be useful in suspecting cases with cow's milk allergic enterocolitis.

Animals↗
PubMed1998

Enterocolitis.

Enterocolitis continues to be the major cause of morbidity and mortality in patients with Hirschsprung's disease. The exact etiology of Hirschsprung's-associated enterocolitis is not known. This review focuses on the clinical aspects, etiology, and therapy of Hirschsprung's-associated enterocolitis.

Enterocolitis↗
PubMed2000

Enterocolitis with pathogenic Escherichia coli infection in renal transplant recipients: case reports.

PURPOSE: We report three cases of enterocolitis associated with pathogenic Escherichia coli infection in renal transplant recipients. METHODS/RESULTS: Patients presented with abdominal pain and diarrhea at 1, 3 and 7 years after living-related renal transplantation. Pathogens of enterocolitis were identified by stool culture as verotoxin-2-producing O157:H7 E. coli, non-verotoxin-producing E. coli 06 and 0125. All patients were basically treated with fluid replacement with additional fosfomycin administration in the patient with O157:H7 E. coli infection. Immunosuppressive drugs were kept at maintenance doses throughout the treatment. CONCLUSION: All patients recovered uneventfully within 10 days after the onset of enterocolitis without severe complications.

Adult↗
PubMed2001

Intestinal permeability in newborns with necrotizing enterocolitis and controls: Does the sugar absorption test provide guidelines for the time to (re-)introduce enteral nutrition?

BACKGROUND: In necrotizing enterocolitis (NEC), (sub)mucosal edema, hemorrhage, ulceration, or necrosis will disturb intestinal integrity, as reflected by an increased intestinal permeability. Enteral substrate is therefore withheld for a variable period up to 3 weeks (in many clinics). The authors used the sugar absorption test to measure intestinal permeability changes in surgically treated necrotizing enterocolitis patients and surgical controls to evaluate the usefulness of this test in timing the (re-)introduction of enteral feeding in NEC patients as intestinal integrity recovers. METHODS: Changes in intestinal permeability to lactulose and rhamnose were evaluated prospectively in 13 children with NEC and 10 operated control patients. The patients were given 1 mL/kg body weight lactulose/rhamnose solution at different time intervals after admission. The lactulose to rhamnose (L/R) ratio was determined by gaschromatography in 4-hour urine samples. RESULTS: The L/R ratios in NEC patients were increased for prolonged periods of time with a tendency to decrease in the third week after the start of NEC. However, in some cases, the increased L/R ratios even exceeded the 3-week period of starvation. High peaks in the L/R ratio were seen in patients suffering from bowel perforation or sepsis. Compared with necrotizing enterocolitis patients, L/R ratios of control patients were increased only in the first days after surgery and normalized more rapidly. The results of the L/R tests in this study corroborated the clinical condition of the patients. CONCLUSIONS: The sugar absorption test shows an individual variability in the recovery of intestinal permeability in a group of seriously ill newborns with advanced stages of NEC. An individual approach in restarting enteral nutrition seems to be justified; however, the optimal time-point to restart enteral nutrition cannot be determined by the sugar absorption test alone. Combining parameters of intestinal integrity and function could enable a more accurate determination of this optimal timepoint. J Pediatr Surg 36:587-592.

Capillary Permeability↗
PubMed1991

[The diagnostic value of the plain abdominal radiogram in differentiating rotavirus-negative and rotavirus-positive necrotizing enterocolitis].

Clinical data and radiographic findings of 32 newborn suffering from necrotising enterocolitis were analysed [12 patients with rotavirus-positive necrotising enterocolitis (RV + NEC), 20 patients with rotavirus-negative necrotising enterocolitis (RV-NEC)]. The presence and degree of pneumatosis intestinalis, portal venous gas and pneumoperitoneum on abdominal radiographs were graded after Kosloske et al. according to "mild, moderate, and severe". Pneumatosis intestinalis occurred twice as often in the ascending colon in RV-NEC compared to RV + NEC, whereas the transverse colon was involved nearly as frequently as the descending colon in both groups. Portal venous gas was present in 10% of the cases with RV-NEC and was absent in RV + NEC. Pneumoperitoneum only occurred in 8% of RV + NEC but in 20% of RV-NEC. Radiographic findings are helpful in the differentiation between both groups of NEC. Conservative therapy is preferable especially in mainly distal colon distribution of pneumatosis intestinalis without pneumoperitoneum.

Diagnosis, Differential↗
PubMedDate not supplied

[Necrotizing enterocolitis: a 12-year retrospective study].

UNLABELLED: Necrotizing enterocolitis (NEC) is the most relevant intestinal acquired complication during the neonatal period. Due to the improvements in perinatal medicine during the last decade, we wanted to work out possible differences in the incidence, diagnosis and clinical courses of NEC during a 12 years period. PATIENTS AND METHODS: All premature or term newborns were eligible for the study, if a necrotizing enterocolitis > or = stage 2a according to Bell was diagnosed between January 1980-December 1991. RESULTS: During the study period, 90 preterm or term newborns were treated for necrotizing enterocolitis, 19 infants were admitted to our hospital for therapy of established NEC from other hospitals. Forty-five infants had a birthweight of < or = 1500 g. During the years 1987-1991 there was an increase in the incidence (4-12/year, median 9/year, compared to 0-6, median 3/year during the period 1980-1986). This was paralleled by an increase in very low birthweight infants admitted to the NICU (1980-1986: 35-45/year, 1987-1991: 83-108/year). Prominent clinical signs: abdominal distension (85 infants), increased gastric residuals (72), bright blood from rectum (56). Median time of manifestation in infants < or = 30 weeks was 17 days, for infants of 31-34 weeks 8 days and for infants of > or = 35 weeks of gestation 4 days. Eleven infants were fed parenterally exclusively before NEC, 12 infants received exclusively breast milk, 67 formula. Surgical treatment was indicated in 51 infants (indication: intestinal perforation or peritonitis diagnosed by abdominal paracentesis). Seventy-one infants survived, in 17 infants who died, NEC or secondary disorders were the main cause. CONCLUSION: With increasing numbers of very preterm infants, the relevance of NEC becomes more and more important. Concepts of prevention and early diagnosis further have to be worked out.

Birth Weight↗
PubMed1986

[Enterocolitis caused by Clostridium difficile. Analysis of 15 cases in adults].

Each of 48 patients with suspected Clostridium difficile enterocolitis after treatment with antibiotics underwent a faecal test in which a Clostridium difficile culture was set up and a cytotoxin test carried out. The detection of Clostridium difficile was positive in 15 cases. Diarrhoea with varying severity was present in all patients, most frequently after medication with the newer cephalosporins. Nine patients also underwent rectoscopy: a typical pseudo-membranous colitis was seen only in 5 of these and a "non-specific" enterocolitis in only 4. Management in 12 patients involved discontinuance of the antibiotic followed by oral vancomycin therapy for an average of 7 days. A female patient suffered a recurrence but responded to a repeat application of vancomycin. The possibility of Clostridium difficile enterocolitis should always be kept in mind when diarrhoea with unclear aetiology occurs during antibiotic therapy. The cytotoxin test and culture identification of Clostridium difficile are suitable routine methods for confirming the diagnosis. In severe cases, treatment should commence without waiting for the microbiological results.

Adult↗
PubMed1987

Intussusception in a premature infant simulating necrotising enterocolitis.

Intussusception in older infants is manifested by bloody stools, colicky abdominal pain and a palpable abdominal mass. In neonates the symptoms are often restricted to vomiting, guaiac positive stools and abdominal distension. These symptoms closely mimic necrotising enterocolitis. Surgical treatment of necrotising enterocolitis should be postponed until perforation of the gastrointestinal tract has occurred, whereas, prompt surgical treatment is recommended for intussusception. We report a case of intussusception that simulated necrotising enterocolitis in a 740 grammes premature infant in the second week of life. The clinical and radiographic features are described and the difficulty in distinction between the two conditions is emphasised. Neonatologists and paediatric surgeons should always include intussusception in the differential diagnosis of abdominal distension and guaiac positive stools in small premature infants.

Diagnosis, Differential↗
PubMed2006

Laparoscopy as an adjunct to peritoneal drainage in perforated necrotizing enterocolitis.

Intestinal perforation in very low birth weight infants with necrotizing enterocolitis has a high morbidity and mortality. We report the use of laparoscopy on day 30 of life in the treatment of a very low birth weight infant (900 g) with perforated necrotizing enterocolitis. The question of laparotomy versus peritoneal drain is ongoing. Laparoscopy may have a major role to play in the answer to this debate. The versatility of laparoscopy enables good visualization of the bowel and organs: a drain can be placed in a port site if there is no fecal contamination and a more conservative approach is warranted, or a conversion to a laparotomy can be undertaken if there are obvious feces or necrotic bowel. We feel that laparoscopy in the initial evaluation of necrotizing enterocolitis is invaluable, and can avoid potentially unnecessary surgery in an already extremely unwell infant.

Combined Modality Therapy↗
PubMed1987

An outbreak of necrotizing enterocolitis. Association with transfusions of packed red blood cells.

Of 187 newborns admitted to a 33-bed, level III neonatal intensive care unit between January 1, 1985 and June 23, 1985, 33 developed necrotizing enterocolitis during their hospital stay. Twenty of the 33 newborns (61%) had onset of symptoms between April 1 and June 23, suggesting clustering during this period. A case-control study, with matching on birth weight class, approximate date of admission to the unit and approximate duration of stay, failed to reveal any association of the syndrome with type or timing of feeding, perinatal hypoxic events, as determined by apgar scores and labor history, or specific microbial organisms. By contrast, however, transfusion of packed red blood cells was highly and significantly associated with the syndrome (odds ratio = 15.1, 95% confidence interval = 2.59-92.51). In addition, therapy with caffeine, with theophylline, and with furosemide were moderately associated with the syndrome, although not significantly so. During this outbreak period, the incidence of necrotizing enterocolitis by birth weight was 30.6% in infants less than 1,500 gm, 10.8% in infants 1,500-2,500 gm, and 11.9% in infants 2,500 gm or more. These findings confirm the importance of low birth weight as a risk factor for development of the syndrome and suggest that insults to volume homeostasis, such as transfusion and use of diuretics, need to be considered as possible mechanisms whereby necrotizing enterocolitis is initiated.

Birth Weight↗
PubMed2000

Successful conservative treatment of neutropenic enterocolitis complicating taxane-based chemotherapy: a report of five cases.

Five cases of acute neutropenic enterocolitis complicating taxane-based chemotherapy are described. During a 34-month period, our department administered 4,600 courses of taxane-based (paclitaxel and docetaxel) chemotherapy to 800 cancer patients. Seven to 10 days postchemotherapy in five patients (0.1% of the given courses), neutropenic fever, abdominal pain, rebound tenderness, and grade II-IV diarrhea (bloody in two cases) developed. Two patients had oral candidiasis, and in two others septic shock developed. Computed tomography scans of the abdomen revealed in all patients thickening of the colon wall and pericolic edema, and a pericolic abscess was revealed in three of them. Both clinical and radiologic findings supported the diagnosis of acute neutropenic enterocolitis. All patients were successfully treated with broad-spectrum antibiotics and recombinant human granulocyte colony-stimulating factor. In conclusion, acute neutropenic enterocolitis is a severe complication of taxane-based chemotherapy. Early diagnosis and appropriate conservative treatment leads to complete recovery. Although rare, this infection is less often associated with other chemotherapeutic regimens.

Acute Disease↗
PubMed1992

Abnormal gut blood flow velocities in neonates at risk of necrotising enterocolitis.

Duplex pulsed Doppler ultrasound was used to determine blood flow velocities in the coeliac axis and superior mesenteric artery in three groups of neonates: a group at high risk of developing necrotising enterocolitis (n = 27) and two control groups, i.e., a nonasphyxiated, appropriately grown group of preterm infants (n = 18) and a group of nonasphyxiated term infants (n = 14). Subjects were studied on the first, second, and fourth days of life. The median peak systolic velocities in the superior mesenteric artery were between 20 and 51% lower in the at-risk group than in the term control group on all 3 days of measurement (p less than 0.05-p less than 0.002). The ratio of peak systolic velocity in the coeliac axis to that in superior mesenteric artery, an index of relative downstream vascular resistance in the superior mesenteric artery, was 42-65% greater in the at-risk group compared with the other two groups on days 1 and 2 (p less than 0.05-p less than 0.001) and significantly greater than the term group on day 4 (73%, p less than 0.002). These data demonstrate that neonates at risk of developing necrotising enterocolitis have abnormal gut blood flow velocities. Furthermore, they provide evidence that an alteration in the splanchnic circulation may be an important factor in the final common pathway that links diverse risk factors for necrotising enterocolitis with clinical disease.

Blood Flow Velocity↗
PubMed2002

Gut hormones in preterm infants with necrotizing enterocolitis during starvation and reintroduction of enteral nutrition.

OBJECTIVES: Gastrointestinal hormones control gut functions in response to enteral nutrition. Diseases involving the gastrointestinal tract, such as necrotizing enterocolitis, may affect gut hormone secretion and therefore influence gut functions. Because bowel rest is an important part of the treatment, infants with this disease are especially at risk for an altered gut hormone secretion and thus for compromised gut functions. METHODS: In the current study, the gastrointestinal hormone profiles of eight preterm infants with an ileostomy after necrotizing enterocolitis (Bell stages 2 and 3) were evaluated during starvation and reintroduction of enteral nutrition. Basal and postprandial plasma concentrations of gastrin, cholecystokinin, and peptide YY were measured with sensitive and specific radioimmunoassays. The results were compared with those of 11 controls. RESULTS: In the patients and the controls, plasma concentrations of all hormones were higher postprandially. The increases in cholecystokinin and peptide YY were significant in the patients. Compared with the controls, all concentrations were higher in the patients, and changes were significant for basal and postprandial cholecystokinin and postprandial peptide YY. CONCLUSIONS: Enteral nutrition stimulates the secretion of gastrointestinal hormones, also in premature infants with a diseased distal small bowel and colon, as in necrotizing enterocolitis. The postprandial increase of peptide YY in patients with an ileostomy indicates that enteral substrate in the colon is not necessary for stimulation of peptide YY secretion.

Cholecystokinin↗
PubMed1987

Successful medical management of neutropenic enterocolitis in adults with acute leukemia.

Seven adults with acute leukemia had a clinical and radiologic diagnosis of neutropenic enterocolitis. Six of the seven patients had granulocyte counts less than 500/microliter. All seven patients responded to intensive medical therapy, including bowel rest, broad spectrum antibiotics, and white blood cell transfusions, and recovered from the neutropenic enterocolitis without surgical intervention. We discuss the clinical spectrum of neutropenic enterocolitis and the favorable results of medical therapy.

Adult↗