Acute hemorrhagic necrotizing enteritis

　　The etiology of acute hemorrhagic necrotizing enteritis has not been fully elucidated. It is currently believed that the onset of the disease is related to the infection of Welchii bacillus (type C gas gangrene bacterium) that produces toxins, which can cause necrosis of intestinal tissue and produce gangrenous enteritis.

　　Severe cases of acute hemorrhagic necrotizing enteritis may have complications such as shock, intestinal paralysis, and intestinal perforation.

　　Acute hemorrhagic necrotizing enteritis has an abrupt onset, with one-third of cases having a history of unclean food intake. Clinically, it is characterized by acute abdominal pain, distension, vomiting, diarrhea, hematochezia, and systemic toxic symptoms.
　　1. Abdominal pain and distension:Abdominal pain is usually sudden, persistent, and may worsen in attacks. The pain is often located around the umbilicus or in the upper abdomen, and some patients may experience generalized abdominal pain. In the early stages, the disease may present with mild abdominal distension, which then becomes more severe.
　　2. Vomiting:After onset, nausea and vomiting occur, with the vomit containing bile, coffee-like, or bloodwater-like substances.
　　3, Diarrhea and hematochezia:The degree varies, with more than 10 times a day. Depending on the location of the lesion, the speed of bleeding, the time spent in the intestines, and the condition of intestinal peristalsis, feces can be fresh blood, broth-like, jam-like, or black stools, often mixed with decayed tissue and a special fishy smell. If the lesion is limited to the small intestine, there is no urgent defecation sensation.
　　4, Systemic toxic symptoms:Due to the translocation of bacteria and endotoxins, systemic inflammatory response can cause fever or hypothermia, malaise or irritability. If delirium or coma occurs, it often indicates serious condition, and multiple organ dysfunction syndrome (MODS) may occur, and intestinal necrosis may occur.
　　5, Symptoms in infants and young children:Atypical, most neonates develop the disease within 3 to 10 days after birth. Due to preterm birth or low birth weight, they are admitted to the intensive care unit, and during the period of artificial feeding or for immature infants due to incomplete swallowing reflex, the retention of gastric contents is found in the stomach, followed by abdominal distension, vomiting, hematochezia, fever or hypothermia, tachycardia or bradycardia, abdominal muscle tension, abdominal distension, erythema of the abdominal wall, and other signs. It is generally believed that the smaller the gestational age, the higher the incidence rate. The incidence rate of low birth weight infants is 12%.

　　To prevent acute hemorrhagic necrotizing enteritis, attention should be paid to the cleanliness and hygiene of diet in daily life, preventing contaminated food from entering the digestive tract. In case of nausea, vomiting, severe abdominal pain with diarrhea, hematochezia, and severe systemic toxic symptoms, seek medical treatment in the hospital as soon as possible. During the treatment process, strengthen supportive therapy, timely supplement water, electrolytes, calories, vitamins, etc., and prevent the occurrence of complications.

　　The diagnosis of acute hemorrhagic necrotizing enteritis not only relies on clinical manifestations, but also indispensable auxiliary examinations.
　　1, Routine blood test:Manifested as an increase in white blood cell count, nucleated left shift phenomenon in smears; decrease in red blood cells and hemoglobin; progressive decrease in platelet count, etc.
　　2, Blood biochemical examination:There may be hypoalbuminemia, electrolyte disturbance, metabolic acidosis, hyperglycemia or hypoglycemia, and other manifestations.
　　3, Liver, kidney and coagulation function:Some cases may show liver, kidney and coagulation dysfunction.
　　4, Stool examination:Ocult blood test is positive.
　　5, Blood and stool bacterial culture:This examination is helpful in judging the infection flora.
　　6, Abdominal X-ray flat film:Early on, most patients may have varying degrees of intestinal lumen inflation and mild widening of the intestinal space. Due to the edema and inflammatory exudation of the intestinal mucosa, the inner edge of the intestinal wall becomes blurred, and with the progression of the disease, the image of intestinal gas accumulation can be found.
　　7, Fiberoptic colonoscopy examination:It can be detected early for intestinal inflammation and bleeding.
　　8, Ultrasound examination:With the continuous accumulation of experience in gastrointestinal imaging, there is a trend to supplement X-ray examination by using this examination method, which will be more convenient and quick.

　　Acute hemorrhagic necrotizing enteritis should be fasting or given a liquid diet according to circumstances. The food should be selected as fine and soft foods rich in nutrition and easy to digest.

　　The treatment of acute hemorrhagic necrotizing enteritis mainly adopts non-surgical methods, strengthens general support therapy, corrects water and electrolyte imbalances, relieves toxic symptoms, and actively prevents and treats toxic shock and other complications. Surgical treatment is only considered when necessary.

　　First, non-surgical treatment
　　1. General treatment: Rest and fasting. During the period of abdominal pain, hematochezia, and fever, complete bed rest and fasting should be maintained until vomiting stops, hematochezia decreases, and abdominal pain subsides. Only then can a liquid diet be introduced, and the amount can be gradually increased afterwards.
　　2. Correcting water and electrolyte imbalance: This disease often has symptoms of dehydration, sodium loss, and potassium loss. The total volume and composition of infusion can be determined according to the condition.
　　3. Correcting hyponatremia: Dehydration, sodium loss, and potassium loss are common in this disease. The total volume and composition of infusion can be determined according to the condition.
　　4. Antibiotic control of intestinal infection: It can alleviate clinical symptoms, and commonly used antibiotics include ampicillin, chloramphenicol, gentamicin, kanamycin, etc., usually used in combination with two types.
　　5. Adrenal cortical hormones: They can alleviate toxic symptoms, suppress allergic reactions, and also help correct shock, but there is a risk of aggravating intestinal bleeding and causing intestinal perforation. Generally, they should not be used for more than 3-5 days; children use hydrocortisone 4-8mg/kg per day or dexamethasone 1-2.5mg/d; adults use hydrocortisone acetate 200-300mg/d or dexamethasone 5-20mg/d, all administered intravenously.
　　6. Symptomatic therapy: Patients with severe abdominal pain can be given meperidine; patients with high fever and restlessness can be given oxygen therapy or physical cooling.

　　Second, surgical treatment
　　The following situations can be considered for surgical treatment: small intestinal perforation; severe intestinal necrosis with purulent or bloody effusion in the abdominal cavity; repeated massive intestinal bleeding with hemorrhagic shock.
　　Surgical methods: For patients with no necrosis or perforation in the intestinal tract, a procaine mesenteric plexus block can be performed to improve blood circulation in the lesion segment; for patients with severe but localized lesions, small intestinal segment resection and anastomosis can be performed; for patients with necrosis or perforation of the small intestine, intestinal segment resection and perforation repair can be performed.