Intestinal obstruction in children due to segmental enteritis: experience in Chittagong, Bangladesh

Acute segmental enteritis is also known as acute segmental necrotizing enteritis, segmental obstructing acute jejunitis, and enteritis necroticans. Children presenting with high fever, P/R bleeding, prostration etc. along with features of intestinal obstruction are not uncommon. Many of these cases had to be operated upon revealing no definite obstructing lesion, except a segment of small gut with different magnitude of inflammation. The principal author encountered many of these cases in the same hospital and also in the previous working places. This study was thus undertaken and this is the first report from Bangladesh on segmental enteritis.

From 1 January 2004 to 31 December 2009, 24 consecutive cases suffering from enteritis were managed. This prospective descriptive study evaluates the sex, age, presentations, physical findings, operative findings, hospital stay, outcome and complications. The inclusion criteria were an acute abdominal presentation, plain radiographic features of intestinal obstruction and intraoperative findings of segmental small intestinal involvement with ischemic lesions without definite obstruction.

Fever and leucocytosis were present in all, abdominal tenderness in 17 and per-rectal bleeding in 15 cases. Jejunum alone was involved in 17, both jejunum and ileum in 5 and ileum alone in 2 cases. Scattered dark patches over the intestinal wall was found in 16, circumferential dusky lesions in 4, perforation in one and frank gangrene in 3 cases. Bacteriology of the peritoneal fluid in 17 cases revealed mixed flora. Histopathology of the mesenteric lymph nodes in 11 cases showed non-specific hyperplasic changes. Histopathology of four resected gut walls showed inflammatory infiltrates. In 17 cases recovery was uneventful. Seven cases suffered different complications including two (8.33%) deaths. One with ileal stricture and another with fecal fistula required reoperation. Mean hospital stay was 10.63 ± 3.00 days. The surviving patients were followed up for at least 6 months and faring well.

Segmental enteritis is occasionally encountered as a cause of acute abdomen in children of Bangladesh. Operative treatment is required and mechanical obstructing lesion was found in none of the cases. Majority of cases improve on intraoperative measures other than gut resections or creation of stoma.