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Small bowel (small intestine)

Inflammatory disorders

Necrotizing enterocolitis


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 20 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Acute, necrotizing inflammation of small bowel and colon in patients with myelosuppression
● Also called typhlitis, neutropenic enterocolitis, ileocecal syndrome
● Most common acquired GI emergency of neonates (eMedicine)
● Common in premature or low birth weight infants, particularly when they start on oral foods at 2-4 days
● Also adults with various myeloproliferative disorders, solid malignancies, post-transplant immunosuppression (eMedicine)
● Affects terminal ileum, ascending colon

Etiology
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● 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)


Drawing

Clinical features
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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
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● Fluids and surgery if gangrene/perforation

Gross images
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Various images

Micro description
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● 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)

Micro images
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Various images

Additional references
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Pediatr Res 2011;69:183, J Pediatr Gastroenterol Nutr 2011;52:140

End of Small bowel (small intestine) > Inflammatory disorders > Necrotizing enterocolitis


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