Enterocolitis

DEFINITION: Inflammation of the small and large intestines, which may be caused by a severe bacterial infection

• ALSO KNOWN AS: Acute infectious diarrhea
• ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system, intestines
• CAUSES: Bacterial infection; unknown for necrotizing enterocolitis
• SYMPTOMS: For bacterial infection, copious and sometimes bloody diarrhea, abdominal pain, vomiting, dehydration, high fever in young children; for necrotizing enterocolitis, poor feeding, abdominal distension or tenderness, decreased bowel sounds, apnea, lethargy, shock, cardiovascular collapse
• DURATION: Acute
• TREATMENTS: For bacterial infection, intravenous fluids and antibiotics; for necrotizing enterocolitis, surgery (intestinal resection)

Causes and Symptoms

Enterocolitis is characterized by copious and sometimes bloody diarrhea, abdominal pain, vomiting, and dehydration. A high fever usually exists in young children. Stool and blood cultures can establish the exact organism involved.

Campylobacter enterocolitis, resulting from infection with Campylobacter bacteria, is the most common bacterial cause of diarrhea. It is endemic in developing countries, and epidemics are seen in Western countries in daycare centers. Salmonella enterocolitis is an infection in the lining of the small intestine caused by Salmonella bacteria acquired through the ingestion of contaminated food or water or exposure to reptiles. This type of enterocolitis can range from mild to severe and lasts from one to two weeks.

A different type of enterocolitis is necrotizing enterocolitis (NEC), the most common gastrointestinal medical emergency occurring in newborns. It is more prevalent in premature infants. NEC may begin with poor feeding, abdominal distension or tenderness, and decreased bowel sounds. If it becomes systemic, then symptoms can include apnea, lethargy, shock, and cardiovascular collapse. Outbreaks of NEC seem to follow an epidemic pattern, suggesting an infectious disease, but a specific causative organism has not been identified. Research suggests that several factors may be involved.

Treatment and Therapy

The treatment of bacterial enterocolitis involves rehydration and, in some cases, antibiotics. In underdeveloped countries, where medical care is poor, enterocolitis causes more than 60 percent of all deaths in children under age five.

Infants with NEC cannot take food by mouth and often must be fed through a central venous catheter. Those with severe disease may require surgical intervention such as intestinal resection. The mortality rate for NEC approaches 50 percent in infants weighing less than 1,500 grams (3.3 pounds).

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