Necrotising enteritis and septic shock: a case report

A. Fulco, A. Cusimano, A. Donadini

Objective

Necrotising enteritis has been described in literature as a clinicopathological entity of an acute abdominal disorder, characterized by patchy or segmental necrosis of varying extent of the wall of jejunum, ileum or colon. It can be associated with gangrene, toxaemia and eventually death in a relevant number of cases.

Methods

This report describes the case of a patient with medical history of rectal cancer which was treated with abdominal perineal resection in December 2011. He was admitted to our hospital with a three day history of abdominal pain associated with nausea after eating raw fish. Abdominal x-rays and computer tomography revealed dilated a small intestine loop with a caliber change in proximity of the terminal colostomy, therefore a naso-gastric tube was placed with clinical improvement. However, during the night, his general condition worsened with rapidly increasing shock parameters. A surgical treatment was decided. At first the patient underwent through a diagnostic laparotomy showing a patchy necrosis of the colon and small bowels wall without any mechanical obstruction. After improvement in intensive care unit he underwent through a second laparotomy with an ileocaecal resection (150 cm of small bowel) and cholecystectomy because of segmental necrosis. We performed an ileocolic anastomosis during the third laparotomy after complete resuscitation. Microbiological laboratories were always negative. After 19 days in Intensive care unit he was admitted to the ward where total parenteral nutrition was progressively decreased and the oral alimentation was gradually reintroduced.

Results

Review of literature cases of necrotising enteritis showed a high mortality rate; delay in diagnosis and treatment represents a threat to the patient’s life. Necrotic intestinal segments must be removed as soon as possible, relaparotomy may be necessary, especially in intra-abdominal infections caused by Clostridium Perfrigens.

Conclusion

Surgery might be a life-saving procedure if effectuated without delay.