Hemorrhagic necrotizing enteritis primarily affects the jejunum, and in severe cases, the entire jejunum and ileum may be involved. The intestinal lumen exhibits segmental hemorrhage and necrosis, with clear boundaries between affected and healthy areas. Children of all ages can be affected, and the disease cause is not yet fully understood.

bubble_chart Clinical Manifestations

1. Age: Mostly seen in children aged 3-12, but can also occur in newborns.
2. Symptoms: Sudden onset, mainly characterized by abdominal pain, vomiting, diarrhea, hematochezia, and fever. In severe cases, toxic shock may occur. Severe cases may also develop toxic intestinal paralysis.
3. Signs: Tenderness and muscle rigidity in the upper and middle abdomen. In cases of toxic intestinal paralysis, abdominal distension and fullness are observed, with weakened borborygmus. Digital rectal examination often reveals bloody stool.

bubble_chart Auxiliary Examination

1. Blood picture: The total white blood cell count ranges between 10.0×10⁹/L and 20.0×10⁹/L, with an increase in neutrophils and a left shift phenomenon.
2. Stool examination: Microscopy reveals a large number of red blood cells. Occult blood is positive.
3. X-ray examination: Abdominal plain films show duodenal dilation, gas distension in the jejunum, ileum, and colon, disappearance of the fat line, and visible fluid levels of varying sizes. Gas distension in the intestinal lumen is most commonly seen in the jejunum.

bubble_chart Treatment Measures

Medical Treatment

The primary focus should be on actively rescuing toxic shock, correcting typical edema and electrolyte disturbances, controlling infections, and improving toxic symptoms.

1. Fasting Early fasting is required, and liquid diet should be gradually introduced after vomiting and hematochezia stop.
2. Correction of Toxic Shock Immediately replenish effective circulating volume, using 2:1 isotonic sodium-containing solution or dextran for intravenous infusion, while correcting acidosis. 654-2 or dopamine may also be selected.
3. Antibiotics Broad-spectrum antibiotics should be chosen. Generally, ampicillin and third-generation cephalosporins are preferred.
4. Adrenal Corticosteroids Hydrocortisone 5–10 mg/(kg·d) or dexamethasone 0.1–0.25 mg/(kg·d) should be administered intravenously. After improvement, prednisone 1–2 mg/(kg·d) can be given orally. The treatment course is generally about 1 week.
5. Correction of Typical Edema and Electrolyte Disturbances.
6. Symptomatic Treatment (1) Abdominal pain: Atropine 0.01 mg/kg per dose, subcutaneous injection, or pethidine 1 mg/kg per dose, intramuscular injection. (2) Abdominal distension and fullness: Gastrointestinal decompression. (3) Hemostasis.

Surgical Treatment

Patients with complications such as intestinal necrosis, intestinal perforation, or intestinal obstruction should undergo surgical intervention.

bubble_chart Differentiation

1. Toxic dysentery: Sudden onset with high fever from the beginning. May be accompanied by circulatory failure and convulsions. Mainly presents with purulent bloody stools. Stool culture may be positive for dysentery bacilli.
2. Intussusception: More common in infants and young children, no fever, obvious symptoms of intestinal obstruction, abdominal mass may be palpable, and rectal examination and X-ray can assist in diagnosis.