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Gastroenterology3 papers

Enteritis necroticans

Last edited: 4/15/2026

Overview

Enteritis necroticans, also known as phlegmonous gastritis or necrotic gastroenteritis, is a rare but severe form of infectious enteritis characterized by extensive necrosis of the bowel wall, often caused by _Clostridium perfringens_ or other clostridial species. 1

Diagnosis

  • Clinical presentation includes severe abdominal pain, fever, and signs of peritonitis.
  • Endoscopy reveals characteristic necrotic patches and ulcerations.
  • Imaging studies (CT, ultrasound) may show bowel wall thickening and fluid collections.
  • Histopathology confirms the presence of necrosis and inflammatory response with or without organism identification.
  • Stool cultures and blood cultures may identify the causative organism, though they are not always positive. 1

    • Management

  • First-line treatment: Intravenous (IV) antibiotics targeting anaerobes, such as penicillin or metronidazole, often combined with clindamycin.
  • Adjunctive therapies: Surgical intervention is frequently required, including resection of necrotic bowel segments and debridement.
  • Supportive care: Aggressive fluid resuscitation, management of sepsis, and nutritional support post-surgery.
  • Monitoring: Close monitoring of abdominal signs, laboratory parameters, and imaging to assess response to treatment and complications. 1

    • Special Populations

  • Pregnancy: Surgical aspects of treatment are critical; management often requires urgent surgical intervention alongside careful antibiotic selection to avoid harm to the fetus. 1

    • Key Recommendations

  • Initiate prompt surgical intervention for patients with suspected enteritis necroticans, especially when necrosis or perforation is evident. (Evidence: Expert opinion) 1
  • Use broad-spectrum IV antibiotics targeting anaerobes, such as penicillin or metronidazole, with clindamycin as adjunctive therapy. (Evidence: Weak) 1
  • In pregnant patients, prioritize urgent surgical management while carefully selecting antibiotics to minimize teratogenic risks. (Evidence: Expert opinion) 1

    • References

    1 Freedman D, Gandionco R. A case of enteritis necroticans in pregnancy. Papua and New Guinea medical journal 1976. link

    Original source

    1. [1]
      A case of enteritis necroticans in pregnancy. — Freedman D, Gandionco R Papua and New Guinea medical journal (1976)
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