Overview
Acute hemorrhagic enterocolitis (AHNE) is a severe, rapidly progressing inflammatory condition characterized by necrosis and hemorrhage in the gastrointestinal tract, often leading to significant morbidity and mortality. 1Diagnosis
Clinical Presentation: Severe abdominal pain, toxic shock, altered mental status, fever, hypotension, abdominal tenderness, and rebound tenderness.
Imaging: Abdominal CT showing bowel wall thickening, colonic necrosis, and peritoneal effusion.
Laboratory Findings: Elevated inflammatory markers, leukocytosis.
Pathology: Necrosis and hemorrhage identified during surgical exploration or post-mortem examination. 1Management
Fluid Resuscitation: Immediate fluid replacement to address hypovolemic shock.
Surgical Intervention: Exploratory laparotomy for definitive management, particularly in cases with significant necrosis or perforation.
Antibiotics: Broad-spectrum antibiotics initiated empirically, though efficacy may vary. 1
Supportive Care: Intensive care support for multi-organ dysfunction, including mechanical ventilation and renal replacement therapy if needed.Special Populations
Elderly: Higher risk of severe complications and mortality, as evidenced by the reported case of a 70-year-old patient. 1Key Recommendations
Prompt Surgical Evaluation: Immediate surgical consultation and exploration for patients with suspected AHNE, especially with signs of necrosis or shock. (Evidence: Weak 1)
Aggressive Fluid Resuscitation: Initiate aggressive fluid resuscitation to manage hypovolemic shock promptly. (Evidence: Weak 1)
Empirical Antibiotic Therapy: Start broad-spectrum antibiotics early in the management course, though efficacy should be monitored closely. (Evidence: Weak 1)References
1 Wu M, Zhou L, Cao L. Acute hemorrhagic necrotizing enterocolitis caused by non-O1/non-O139 Vibrio cholerae infection: A case report. Medicine 2021. link
2 Kazama I, Nakajima T. Acute enterocolitis causing an appendicitis like symdrome. Le infezioni in medicina 2018. link