Small bowel (small intestine)
Inflammatory disorders
Necrotizing enterocolitis

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 8 August 2018, last major update August 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Necrotizing enterocolitis[TI] small bowel[TIAB]

Cite this page: Gulwani, H. Necrotizing enterocolitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/smallbowelnecrotizingent.html. Accessed October 20th, 2018.
Definition / general
Etiology
  • Intestinal bacteria invade immature intestinal epithelium, causing subsequent inflammation and tissue necrosis
  • Bacteria in food produce more cytokines and injure mucosa
  • May be due to TNF receptor 1 dependent depletion of mucus which occurs in immature small intestine (Am J Physiol Gastrointest Liver Physiol 2011;301:G656)
  • May also be due to deranged intestinal blood flow (J Pediatr Surg 2011;46:1023)
Diagrams / tables

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TLR4 signaling in pathogenesis of necrotizing enterocolitis

Clinical features
  • Symptoms: mild GI disturbance or fulminant illness with intestinal gangrene, perforation, sepsis, shock
  • Complications: short bowel syndrome, malabsorption (due to ileal resection), strictures, recurrence
Treatment
  • Fluids and surgery if gangrene / perforation
Clinical images

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Intraoperative (Figure 25b)

Gross images

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Various images

Various images (Figure 1c)

Microscopic (histologic) description
  • Early: mucosal edema, hemorrhage, necrosis
  • Late: hemorrhagic and gangrenous bowel wall, fibrous strictures; often pneumatosis cystoides intestinalis
  • After recovery, Paneth cell hyperplasia; colon also shows metaplastic Paneth cells (Pediatr Res 2011;69:217)
Microscopic (histologic) images

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Various images