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INTRODUCTION
Necrotizing enterocolitis is an acute disease that primarily affects premature neonates of low birth weight, and has a very high morbidity and mortality. The incidence in adults is significantly less, with lower mortality rates. The overall outcome depends on clinical staging and radiological and haematological parameters. Of those who survive, many are left with complications related to short gut syndrome.
CASE REPORTS
Case 1A 35-year-old male presented with acute generalized abdominal pain, vomiting and fever of three days' duration. He was febrile and tachycardic. The abdomen was distended with minimal tenderness, and rectal examination was normal. Haematological investigations were normal except for a WBC count of 6,900/cu mm, and biochemical investigations showed a serum albumin of 1.8 g%. A plain abdominal X-ray showed free air under the diaphragm. The clinical picture with a normal leucocyte count did not fit into the classical features of perforative peritonitis, and so a CT scan abdomen was done. The CT identified moderate ascitis and stranding of fat planes around the caecum. Exploratory laparotomy revealed gross purulent peritonitis with three perforations in the thickened terminal ileum - each about 2 to 3 mm in diameter [Figure:1]. The caecum and ascending colon were congested and oedematous. A right hemicolectomy was done and the terminal ileum and transverse colon were brought out as separated stomas. He had an uneventful but prolonged postoperative course. Histopathology of the resected specimen showed extensive ulceration of the ascending and transverse colon and terminal ileum, of no specific aetiology.
The continuity of bowel was restored six months later with an ileo-transverse anastomosis.
Case 2A 44-year-old male presented with clinical features suggestive of acute intestinal obstruction of seven days' duration and signs of peritonism. Apart from a high WBC count of 14,600/cu mm, haematological and biochemical investigations were normal. Radiological investigations confirmed the clinical impression of small bowel obstruction and cholelithiasis. Laparotomy showed gross peritonitis with perforation in gangrenous segments of the terminal ileum. Around three feet of the small bowel was resected and a primary anastomosis performed. Histopathology revealed a non-specific picture of infarction necrosis of the bowel wall without any evidence of major vessel thrombosis.
Case 3A 55-year-old male presented with abdominal pain of five days' duration and on examination was found to have...