Colon
Noninfectious colitis
Necrotizing enterocolitis
Author: Hanni Gulwani, M.B.B.S.
Last author update: 1 May 2013
Last staff update: 30 September 2020
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: necrotizing enterocolitis [title] colon
Table of Contents
Definition / general | Etiology | Clinical features | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosisCite this page: Gulwani H. Necrotizing enterocolitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonNEC.html. Accessed April 19th, 2024.
Definition / general
- Acute, necrotizing inflammation of terminal ileum or ascending colon, common at day 2-4 in premature or low birth weight neonates (eMedicine #1, #2, J Clin Pathol 1979;32:1090)
- May be associated with Hirschsprung disease, thrombosis of abdominal aorta, H2 blockers (Pediatrics 2006;117:e137), chemotherapy for hematopoietic malignancies (Int J Hematol 2005;82:319)
- Mortality rate of 15-30% (Semin Fetal Neonatal Med 2011;16:145); poorer survival in preterm infants of HIV+ mothers (Pediatr Dev Pathol 2012;15:293)
Etiology
- Oral feeding of neonates with immature gut immune system causes release of proinflammatory cytokines; bacteria in food produce more cytokines which injure mucosa; intestinal blood flow may be disturbed
- IL10 may prevent by attenuating intestinal inflammation (Am J Surg 2012;203:428)
Clinical features
- Symptoms: abdominal distention, loss of bowel sounds, blood-stained stool
- Complications: bowel perforation, short bowel syndrome, malabsorption (due to ileal resection), strictures, recurrence
Treatment
- Fluids and surgery if gangrene/perforation
Gross description
- Necrotic mucosa, submucosal gas-filled cysts
Gross images
Images hosted on other servers:
In situ
Thickened wall, mucosal ulceration, cyst-like spaces
Transverse section shows cyst-like spaces in wall
Alimentary tract
Small intestine
Microscopic (histologic) description
- Early: mucosal edema, hemorrhage, necrosis, pneumatosis cystoides intestinalis
- Late: hemorrhagic and gangrenous bowel wall with strictures
Microscopic (histologic) images
Images hosted on other servers:
Hemorrhagic necrosis
Mucosal necrosis and cyst-like spaces in submucosa
Submucosal cyst-like spaces
Lined by flattened cells
Subserosal lymph node with cyst-like spaces
Differential diagnosis
- Candidiasis: see Fetal Pediatr Pathol 2010;29:172
