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PubMedDate not supplied

Yersinia enterocolitis in iron overload.

Yersinia enterocolitis with peritonitis and septicaemia developed in a 4-year-old child with thalassemia intermedia and iron overload. It is likely that the illness was exacerbated by continued administration of desferrioxamine, a bacterial siderophore, which facilitated systemic spread of Yersinia. It is recommended that Yersinia enterocolitis be considered in children with iron overload and that desferrioxamine be discontinued and prophylactic antibiotics be administered while Yersinia is sought.

Child, Preschool↗
PubMed1995

Patient assessment skills: assessing early cues of necrotizing enterocolitis.

A study is presented utilizing the critical decision method to elicit knowledge from neonatal intensive care unit nurses regarding the assessment of infants at risk for necrotizing enterocolitis. Researchers were successful in eliciting knowledge not available in current nursing texts, including a framework for considering necrotizing enterocolitis and problem-solving strategies used by experienced nurses. Implications for nurse instruction and potential applications of this information are discussed.

Cues↗
PubMed1975

Death from pseudomembranous enterocolitis.

During the past 2 years at the Los Angeles County-University of Southern California Medical Center (LAC-USC), there have been 2 deaths from pseudomembranous enterocolitis. Each of these deaths occurred postoperatively in previously healthy women who received pronlonged antibiotic prophylasix. The implications of these poor therapeutic results are discussed. The distinctive clinical symptology of a patient with pseudomembranous enterocolitis is described, and current treatment recommendiations are presented.

Adult↗
PubMed1979

Asymptomatic cecal stenosis after necrotizing enterocolitis.

Survival of infants with necrotizing enterocolitis may be complicated by intestinal stricture(s) as a result of healing of ischemic segments of bowel. An asymptomatic cecal stenosis not visible on barium enema was identified at operation for reestablishment of intestinal continuity. Infants recovering from acute necrotizing enterocolitis deserve continued surveillance for mechanical and functional abnormalities of the gastrointestinal tract. Patency of the intestinal lumen distal to the ostomy site should be clearly demonstrated by the surgeon when continuity is reestablished.

Cecal Diseases↗
PubMed1995

Surgical management of pediatric necrotizing enterocolitis.

Necrotizing enterocolitis is one of the most common gastrointestinal emergencies observed in neonatal intensive care units. Despite extensive research efforts, the etiology and pathogenesis of necrotizing enterocolitis remain unclear. Investigators have attempted to identify various laboratory and clinical factors that would serve as criteria for surgical intervention. Unfortunately, the most sensitive and specific tests detect only advanced disease and perforation. The mainstay of surgical treatment is resection with enterostomy, although resection and primary anastomosis is useful in selected cases. In addition, some neonates may benefit from peritoneal drainage, second look procedures, or proximal diversion.

Anastomosis, Surgical↗
PubMedDate not supplied

Neonatal necrotizing enterocolitis: diagnosis, management, and pathogenesis.

The diagnosis of neonatal necrotizing enterocolitis is one of great concern to pediatric and neonatal clinicians. Intravenous access remains an integral part of the medical and surgical management of infants with this diagnosis, and the infusion nurse is intimately involved in the care of these patients. This article discusses the definition of necrotizing enterocolitis, presents current knowledge regarding its basic pathophysiology, and identifies common and rare sequelae of this oftentimes devastating disease of premature infants. Medical and surgical management goals of therapy are described. This overview will aid the infusion nurse in caring for these patients.

Colectomy↗
PubMed1995

Trends in pediatric ostomy surgery: intestinal diversion for necrotizing enterocolitis and biliary diversion for biliary hypoplasia syndromes.

Ostomies are placed in children for different indications than in the older population. Many ostomies of childhood are placed because of congenital or neonatal problems that require temporary or long-term diversion to stabilize the neonatal patient. Necrotizing enterocolitis, the most common reason for placement of neonatal colostomies and ileostomies, is increasing in frequency as more prematurely born infants survive. Recently, there has been an increase in treatment of various biliary hypoplasia syndromes with biliary cutaneous diversion. Children with biliary hypoplasia syndromes are a challenging group of patients who frequently can be helped by ostomies. This article reviews current information on biliary cutaneous diversion for the biliary hypoplasia syndromes and intestinal diversion for necrotizing enterocolitis.

Bile Ducts↗
PubMed2004

Severe cytomegalovirus enterocolitis in an immunocompetent infant.

Gastrointestinal cytomegalovirus infection is a common opportunistic infection in immunocompromised patients. It is a rare cause of enterocolitis in immunocompetent hosts. We present a case of severe cytomegalovirus enterocolitis causing intractable diarrhea in a previously healthy infant. The child was successfully treated with intravenous ganciclovir.

Cytomegalovirus↗
PubMed2005

Invasive candidal enterocolitis followed shortly by fatal cerebral hemorrhage in immunocompromised patients.

Two immunocompromised adult patients (male, 43 years of age; female, 50 years of age) are described who developed unusual and similarly unique complications. After chemotherapy, both presented with abdominal pain and severe bloody diarrhea. Initial blood cultures were negative, and abdominal CT showed pneumatosis and thickening of colonic wall. Colonoscopy showed severe right-sided colitis. Relentless bloody diarrhea necessitated emergency right hemicolectomy in both cases. Pathologic examination of the specimens showed extensive and severe hematogenous Candida enterocolitis. Both patients died of acute cerebral hemorrhage within 3 days of hemicolectomy. Autopsy, performed on 1 of the 2 cases, showed diffuse severe cerebritis and cerebral hemorrhage secondary to hematogenous invasive candidiasis. This sequence of events is not documented in the English literature on candidal enterocolitis, which is reviewed.

Adult↗
PubMed2005

Long-term outcome of intractable ulcerating enterocolitis of infancy.

BACKGROUND: Chronic enterocolitis is rare in infancy and accounts for less than 0.5% of all newly diagnosed inflammatory bowel disease (IBD) in the UK. Presentation at this young age is usually indicative of underlying immunodeficiency/immunodysregulation. A group of such infants suffer intractable ulcerating enterocolitis of infancy (IE) in which there is a pan-enteritis with marked oro-anal involvement and deep flask like mucosal ulcers throughout the colon. METHODS: Retrospective review of presenting features, treatment and long-term outcome in a series of 8 children with typical IE. RESULTS: The 8 children were aged between 1 and 4 weeks at onset (median 2 weeks, mean 2.3 weeks), of which 7 were followed up for 2-22 years (median 7.5 years, mean 11 years). All 8 children had an intractable disease course requiring a colectomy for control of symptoms. The median age at colectomy was 1.7 years (range 4 months-4 years). Three children developed a generalised lymphadenopathy due to uncontrolled EBV-related lymphoid proliferations (ages 4, 12, 18). These comprised a monomorphous B-lymphoycte lympho-proliferative disorder, a large pleomorphic follicular lymphoma, and a high grade pleomorphic B cell non-Hodgkin's lymphoma. CONCLUSIONS: Infants with IE have a high risk of developing lymphomatous proliferations that appears to be related to the underlying immunodysregulation. Use of aggressive immunosuppression and acquisition of EBV infection appears to accelerate this process; hence we advocate early colectomy in confirmed cases. In children with IE screening for EBV and vigilance for abnormal lymphoid proliferations is paramount.

Adolescent↗
PubMed2003

Erosive enterocolitis in mycophenolate mofetil-treated renal-transplant recipients with persistent afebrile diarrhea.

BACKGROUND: Diarrhea is the most frequently reported adverse event in mycophenolate mofetil (MMF)-treated transplant patients. The aim of this study was to explore the gastrointestinal tract in MMF-treated renal transplant recipients with persistent afebrile diarrhea to characterize its nature and etiology. METHODS: Renal transplant recipients with persistent afebrile diarrhea (daily fecal output >200 g) were prospectively investigated for infections, morphologic, and functional (gastrointestinal motility and intestinal absorptive capacity) integrity of the gastrointestinal tract; 26 patients met the inclusion criteria. RESULTS: All but one patient had an erosive enterocolitis. Seventy percent of the patients had malabsorption of nutrients, contributing to the diarrhea. In +/-60%, an infectious origin was demonstrated and successfully treated with antimicrobial agents without changes in immunosuppressive regimen. In +/-40%, no infection occurred, but a Crohn's disease-like pattern of inflammation was noted. These patients also had a less pronounced bile-acid malabsorption but a significant faster colonic transit time, correlating with the trough level of mycophenolic acid (MPA). Cessation of MMF, however, was associated with allograft rejection in one third of these patients. CONCLUSIONS: Persistent afebrile diarrhea in renal transplant recipients is characterized by erosive enterocolitis, which is of infectious origin in +/-60%. In +/-40%, a Crohn's disease-like (entero-)colitis was present. Because reduction or cessation of MMF was the only effective therapy, MPA or one of its metabolites may be suggested as a possible cause. However, reduction or cessation of MMF was associated with an increased risk for rejection.

Adult↗
PubMed1999

Oligofructose contributes to the protective role of bifidobacteria in experimental necrotising enterocolitis in quails.

Bifidobacteria are dominant in the gut of full-term infants, although colonisation by them is often delayed in preterm neonates. Bifidobacteria are recognised to have beneficial effects on digestive disorders and they might prevent neonatal necrotising enterocolitis (NEC), a gastrointestinal disease that predominantly affects premature infants. They have been shown to protect gnotobiotic quails against NEC-like lesions when the birds were inoculated with faecal flora from preterm infants, decreasing the clostridial population. The present study was designed to investigate whether oligofructose, which stimulates the activity of bifidobacteria, may enhance their protective role. Experiments were done in eight groups of germ-free quails for 28 days. The groups differed as to their bacterial status, diet and environment. Quails were inoculated with one of two flora from premature twins. The first flora included Bifidobacterium pseudo-catenulatum, Escherichia coli and no clostridia. The second flora included clostridial species and was associated with B. infantis-longum. Caecal bacterial population and metabolism changes were investigated with a lactose (6%) diet versus a lactose-oligofructose (3%-3%) diet, either in a gnotobiotic environment or in an ordinary environment permitting post-colonisation by exogenous bacteria. In both environments and with both flora, oligofructose significantly increased the level of bifidobacteria and this was associated with a decrease of E. coli or C. perfringens and C. ramosum. The bacterial changes in the ordinary environment depended on the initial composition of the microflora and the colonisation resistance against exogenous bacteria was more efficient with the flora that included B. pseudo-catenulatum. The changes in caecal pH and short-chain fatty acids were minimal. It was demonstrated that, irrespective of the environmental conditions, the use of oligofructose helped to prevent the overgrowth of bacteria implicated in necrotising enterocolitis in preterm neonates.

Animals↗
PubMed2005

Clostridium difficile associated severe enterocolitis: a feature of Hirschsprung's disease in a neonate presenting late.

We report a case of Hirschsprung's disease presenting late in the newborn period with severe enterocolitis and Clostridium difficile toxin detectable in the stool. Enterocolitis associated with Hirschsprung's disease is a potentially fatal complication that may occur at presentation or later in the life of an affected child. Its association with toxin-producing Clostridium difficile growth in the bowel may be under recognized, especially in newborns.

Bacterial Toxins↗
PubMed1986

Neonatal necrotizing enterocolitis: a cause of gastric metaplasia in the mid-ileum.

Following neonatal necrotizing enterocolitis in a premature Aboriginal baby, a stricture developed in the distal small intestine. At laparotomy a 1.0 cm stricture was found in a 25 cm thick-walled, oedematous segment of the mid-ileum. Biopsy demonstrated antropyloric-type ectopic mucosa and, therefore, the oedematous segment was removed. The resected specimen contained several distinct areas of flat antropyloric gastric mucosa as well as ileal mucosa. Although no acid-producing cells could be demonstrated, mucosal ulceration was prominent in several areas. Scanning electron microscopy demonstrated gastric pits. Immunoperoxidase technique for gastrin failed to demonstrate gastrin-containing cells. It is believed that this mucosa represents a metaplasia that has been induced in response to mucosal damage, which in turn was initiated by necrotizing enterocolitis. It is believed this would represent the first reported case.

Choristoma↗
PubMed1994

Campylobacter jejuni enterocolitis causing peritonitis, ileitis and intestinal obstruction.

Patients with Campylobacter enterocolitis may come to laparotomy due to the severity of abdominal symptoms and signs, although only two patients with intestinal inflammation have been described and in neither was the histopathology documented. A case of a 52-year-old male who had a typical diarrhoeal illness of Campylobacter enterocolitis diagnosed on stool culture is reported. Despite appropriate treatment he developed signs and symptoms consistent with small intestinal obstruction. Laparotomy revealed peritonitis and thickened distal ileum with transmural inflammatory changes on histopathology. These changes were shown to have completely resolved at a second laparotomy, required for persistent obstruction due to adhesions. Recurrent adhesions culminated in a third laparotomy. The clinical, operative and histopathological findings may be confused with Crohn's disease.

Campylobacter Infections↗
PubMed1995

Phlegmonous enterocolitis: a rare form of inflammatory bowel disease.

Phlegmonous enterocolitis is a rarely encountered and almost universally fatal bacterial infection seen most often in the alcoholic population. Despite being first described in 1842, fewer than 60 cases have been reported. The role of surgical management in this condition is unknown. We present a case of phlegmonous enterocolitis with a successful outcome after total colectomy.

Adult↗