I quite agree about the diagnosis, as a matter of
fact this type of enteritis is well documented. Enterocolitis
necroticans or pigbel is a rare condition characteristically affecting
chronically malnourished people who abruptly increase their intake of
protein. The classic presentation of the disease as seen in the highlands of
Papua New Guinea is that of a necrotising enterocolitis after the ritual
ingestion of contaminated pork.
Pig Bel is a form of acute, segmental, necrotising enteritis
presenting as a common and life-threatening disease among the people
(particularly the children) of the Highlands of Papua New Guinea. It relates
to the consumption of pig meat and is thought to be caused by Clostridium
welchii type C (an organism not usually present in the human intestine), the
organism being transmitted to man by means of contaminated pig meat. Pig Bel
resembles the diseases called "Darmbrand" which occurred in Northern Germany
in the years that immediately followed World War II. Darmbrand was associated
with a Clostridium welchii infection, possibly precipitated by malnutrition.
It disappeared within a few years of its recognition. Conditions that closely
resemble the clinical and pathological features of Pig Bel have been reported
from Uganda and Thailand. In these countries, only a few cases have been
encountered and they have not been associated with the eating of pig meat or
with a clostridial infection. in communities where protein deprivation, poor
food hygiene, epochal meat feasting and staple diets containing trypsin
inhibitors co-exist. Such human habitats occur in Africa, Central and South
America, western Pacific, Asian and south-east Asian cultures. Isolated
outbreaks of necrotising enteritis have been reported from, Malaysia and
Indonesia . Enteritis necroticans is preventable by vaccination,
Necrotising Enteritis (NE) is a two-stage process. In stage 1, a
necrotic focus is established in the intestinal mucosa-submucosa by
'initiating' factors of vascular (functional or organic) or microbial
(exotoxic, endotoxic, or Shwartzman) origin. Functional circulatory
insufficiency in the intestine is of particular relevance to NE in neonates
and in adults with traumatic shock or cardiac insufficiency. The jejunal
and--to a lesser extent--the ileal microcirculation appear to be particularly
vulnerable to microcirculatory insufficiency. Ninety-seven per cent of NE
occur in the small intestine, of which 76% involve the jejunum alone or as a
part of a jejunoileitis. These 'initiating' factors act either singly or
synergistically with 'promoting' factors (changes in the volume, composition,
or pH of the diet, intestinal stasis, or bacterial factors) in the
establishment of necrotic foci in the intestine. Stage 2 results from the
colonisation of the necrotic foci by intestinal clostridia, the toxigenic
capacity of which will determine the progress of the intestinal lesion.
Clinically established NE is essentially gas gangrene of the intestinal wall.
Bacteriological findings (microscopic, cultural, and serological) support a
pathogenetic role of Cl. welchii in the established stages of necrotising
Acute non-obstructive necrotising enterocolitis in adults is
characterized by pathological features: it is an intestinal necrosis
beginning in the mucosa, without obstruction of the mesenteric vessels. .
Management is medical and/or surgical; it includes alleviation of the
symptoms in intensive care unit, attempts at producing local vasodilatation
whenever possible and resection of the intestinal segment affected. In many
cases the diagnosis is made at exploratory laparotomy.
The indications for surgery include perforation, peritonitis and
persistent intestinal obstruction. It is doubtful whether laparotomy is
indicated in those children with rapid deterioration and simple peritoneal
drainage in very sick infants as described. The mortality rate of operated
children is around 40%, which is in accord with published literature. The
possibility of intestinal stenosis developing and producing intestinal
obstruction is stressed.