Acute hemorrhagic enteritis refers to an acute inflammatory condition of the intestines with an unknown etiology. The disease is named for its primary symptom, bloody stools.
Pathology
Lesions primarily involve the jejunum or ileum, often segmental but may become confluent in severe cases. The intestines exhibit dilation, with the lumen filled with dark red hemorrhagic fluid and necrotic materials. The intestinal wall shows congestion, edema, infiltration of inflammatory cells, extensive hemorrhage, necrosis, and ulceration, which may lead to perforation. Cloudy or hemorrhagic effusions may be present in the abdominal cavity.
Clinical Manifestations
Key clinical manifestations include acute abdominal pain, abdominal distension, vomiting, diarrhea, bloody stools, and systemic signs of toxicity. Abdominal pain is characteristically colicky or persistent with paroxysmal exacerbations, often followed by diarrhea. Stools are typically bloody, watery, or appear as foul-smelling jelly-like material. Associated symptoms include fever, nausea, and vomiting. In some cases, abdominal pain may be mild or absent, with bloody stools being the dominant symptom. Intestinal necrosis or perforation can lead to pronounced signs of peritonitis, and severe cases may progress to toxic shock. Differential diagnosis includes intussusception, Crohn's disease, toxic bacterial dysentery, and acute intestinal obstruction.
Treatment
Non-surgical management is generally employed and includes:
- Fasting and gastrointestinal decompression;
- Maintenance of homeostasis through correction of water, electrolyte, and acid-base imbalances, with blood transfusion if necessary;
- Use of broad-spectrum antibiotics and metronidazole to control intestinal bacteria, particularly anaerobes;
- Prevention and treatment of septicemia and toxic shock;
- Provision of parenteral nutrition to supply nutritional support while allowing the gastrointestinal tract to rest.
Surgical intervention is indicated in specific scenarios:
- Presence of significant peritonitis or purulent/hemorrhagic effusion on abdominal paracentesis, suggesting intestinal necrosis or perforation;
- Uncontrollable intestinal bleeding;
- Intestinal obstruction that does not resolve with conservative measures.
For cases involving localized intestinal necrosis, perforation, or extensive bleeding, partial resection with anastomosis of the affected intestinal segment may be performed. In cases of widespread disease or severe systemic illness, removal of perforated or necrotic segments with exteriorization of both distal and proximal ends may be necessary, with a second-stage anastomosis planned later.
In severe cases, most of the intestinal tract may be involved. Careful evaluation of intestinal viability is critical during surgery to prevent unnecessary extensive resection prompted by inflammatory edema or patchy pinpoint hemorrhages, which could result in postoperative short bowel syndrome.