ADULT NECROTIZING ENTEROCOLITIS AND NON OCCLUSIVE MESENTERIC ISCHEMIA
Description
• Case 1 (guy, 45 years old)
• Presentation: Shock, dark loose stools, and acute stomach pain lasting five days.
• Results: ascending colon, gangrenous cecum, gangrenous ileum (4 ft), and pneumoperitoneum → fecal peritonitis.
• Result: Multisystem failure caused death on the fifth postoperative day.
• Histopathology: No significant vascular thrombosis, many ulcerations, and infarction necrosis.
• Case 2 (guy, 24 years old)
• Presentation: vomiting, distension, discomfort, and dark stools during the past two days.
• Results: Fecal peritonitis with ileal perforation; intestinal blockage on X-ray.
• Result: After three months, the ileostomy closed; recovery was good.
• Histopathology: moderate cecal inflammation and transmural necrosis with neutrophil infiltration.
• Case 3 (guy, 37 years old)
• Presentation: vomiting, peritonitis, bloody stools, and abdominal pain for two days.
• Results: congested cecum, two gangrenous distal ileal perforations, and fecal peritonitis.
• Result: Extended recuperation; anastomosis seven months later.
• Histopathology: Necrosis of the infarction without thrombosis of the vessels.
• Case 4: A male 55-year-old with diabetes and hypertension
• Presentation: vomiting, bloody diarrhea, and excruciating agony that lasted for five days.
• Results: Gangrenous, continuous invasion of the ascending colon and nearly the entire small bowel (no skip lesions).
• Results: Died the next day.
• Conclusion: Non-Occlusive Mesenteric Ischemia (NOMI) is most likely
◉ Summary of the Discussion
• Causes:
• Infection, inflammation, and circulation disruptions are among the potential causes; this is unclear.
• The following organisms were implicated: viruses (Corona, Rota), Pseudomonas, Clostridium, E. Coli, Enterobacter, Klebsiella, and Staph. epidermidis.
• Pigbel-like Clostridium perfringens type C β-toxin was also implicated.
• Necrosis may be brought on by mesenteric vasoconstriction-induced hypoxia-reperfusion damage (as in NOMI).
◉ Pathophysiology:
• Decreased mesenteric blood supply leads to ischemia, which in turn causes mucosal necrosis, bacterial invasion, and full-thickness necrosis.
• Infection occurs before ischemia in adults, which is different from neonatal NEC.
◉ Histopathology
• necrosis from mucosal to transmural.
• There is no indication of thrombosis or significant vascular blockage.
• Common (seen in 3/4 of instances) are skip lesions.
◉ Clinical and Radiological Features:
• Non-specific: dilated loops, thumbprint, and pneumoperitoneum.
• Absence of portal venous gas and pneumatosis intestinalis, which are characteristic with newborn NEC.
• Peritonitis, bloody diarrhea, metabolic acidosis, and hyponatremia are typical symptoms.
◉ Typical Elements of Cases:
• All men, non-vegetarians, smokers, and drinkers.
• Low socioeconomic position, inadequate nutrition, and eating in unsanitary settings.
• All from the same area → potential infectious or environmental connection.
◉ Microbiology:
• Klebsiella and E. Coli are frequent isolates.
• No Clostridium perfringens was found.
◉ Diagnosis Differential:
• Case 4 is probably NOMI because of age, comorbidities, and the absence of skip lesions.
Protocol
◉ Management:
• Medical: Vasodilation (papaverine in NOMI), resuscitation, acidosis correction, and antibiotics.
• Perforation, necrosis, or increasing infection are indications for surgery. involves stoma development and necrotic bowel resection.
• Advanced cases: Few choices because of the widespread necrosis.
• CASE 1 Surgery: 3 foot small bowel resection + right hemicolectomy → ileostomy.
• CASE 2 Surgery: Ileo-transverse anastomosis, distal ileal resection, covering ileostomy, and limited right hemicolectomy.
• CASE 3 Surgery: Closed transverse colon, ileostomy, and right hemicolectomy with gangrenous ileum resection.
• CASE 4 Surgery: No effort at resection was made.
• The issue with patient education is that people with long-term conditions (such diabetes or high blood pressure) frequently lack the information and abilities necessary to manage their conditions on their own, which can result in complications and poor health outcomes.
• Management/Interventions: Nurses provide tailored patient education sessions that cover topics such as the nature of the condition, medication compliance, nutrition, exercise, and self-monitoring methods.
• To reaffirm learning and dispel ambiguities, they employ written materials, demonstrations, and frequent follow-ups. Better disease control and patient self-management are the results of this strategy.
• Medication Management Issue: Adverse drug events and hospital readmissions, particularly in adults and the elderly, are frequently caused by medication errors and noncompliance with recommended therapies.
• Interventions and Management: At every change in care, nurses reconcile medications, teach patients and their families how to take them correctly, and keep an eye out for adverse effects.
• To increase adherence and lower mistakes, they arrange prescriptions and send out reminders.
• Healthcare-associated infections (HAIs) are a common problem in hospitals and long-term care facilities, leading to higher morbidity and healthcare expenses. This presents an infection control challenge.
• Management/Interventions: Nurses strictly adhere to aseptic procedures, hand hygiene guidelines, appropriate catheter care, isolation measures, and environmental cleaning, and they also teach others about these topics.
• They lower HAI rates by keeping an eye out for early infection symptoms in patients and responding quickly to report and treat suspected cases.
• The issue of pain management: People who experience either acute or chronic pain frequently complain of inadequate • pain management, which impairs their quality of life, causes them to become distressed, and limits their mobility.
• Management/Interventions: Nurses employ non-pharmacological strategies include positioning, applying heat or cold, relaxation techniques, and distraction in addition to periodically assessing pain using standardized scales and administering prescribed analgesics.
• In order to improve comfort and satisfaction, they work with doctors to develop pain management regimens and teach patients coping mechanisms.
◉ Problem with Fall Prevention:
• Safety and recuperation are impacted by the high frequency of falls and associated injuries among older persons and those who are at risk because of physical or cognitive impairment.
• Management/Interventions: Nurses use alarms and assistive equipment, monitor high-risk areas, educate patients and family, promote fitness programs, assess individual fall risk, and make sure safe conditions are maintained.
• They successfully lower the number of falls by using safety measures like bed rails and supervised walking.
◉ Wound Care Management Issue:
• Inadequate care for patients with wounds (such as burns, ulcers, or lacerations) can cause delayed healing and a higher risk of infection.
• Nurses offer evidence-based wound care, which includes cleaning, changing dressings, keeping an eye on infections, and providing nutritional support.
• They promote quicker healing and reduce infection rates by teaching patients and caregivers how to take care of wounds at home.
Notes
FOR MORE DETAILS https://pmc.ncbi.nlm.nih.gov/articles/PMC3162722/?utm_source=chatgpt.com
