Hemorrhagic Necrosis of the Gastrointestinal Tract and Its Relation to Cardiovascular Status

Abstract

Seventy-five cases of hemorrhagic necrosis of the gastrointestinal tract were analyzed and compared with the entire autopsy population as control. The disease occurred most frequently in association with shock, which was present in 80 per cent of the cases with the gastrointestinal lesions. The incidence of heart disease was higher in the cases of hemorrhagic necrosis than in the control group. The role of cardiac dysfunction in the etiology of hemorrhagic necrosis is emphasized as are the roles played by the bacterial toxins and shock. All three conditions have been shown to result in marked reduction of the intestinal blood flow and venous stasis. Hemorrhagic necrosis of the gastrointestinal tract probably represents a conglomeration of microinfarcts of the mucosa secondary to markedly decreased local blood flow. Vasopressor agents have produced no beneficial effect; the effect of vasodilators remains to be determined.

Pseudomembranous colitis.

“…B. Price and D. R. Davies and intense congestion are a prominent feature of the acute varieties of ischaemic colitis (Wilson and Qualheim, 1954;Ming, 1965) (Fig. 10), and we have found this feature only rarely in pseudomembranous colitis, and even then the ghost outlines of the distended glands remain.…”

Acute Ischemic Enteropathy

“…In one series, postmortem examination of 370 heart patients out of 1.451 consecutive autopsies revealed a 33% incidence of hem orrhage or ulcers in the gastrointestinal mu cosa, whereas gastrointestinal symptoms ap peared in only a small number of these heart patients with AIE [ 12], In another series clear evidence of this disease was found in 4.8% of 1,535 consecutive adult autopsies [13].…”

Phlegmonous colitis: a specific and severe complication of chronic hepatic disease

“…To confirm the histologic specificity of PC, we investigated all other autopsy cases that showed inflammatory lesions in the large intestine (n=165, 1961-1984), including the cases of circulatory-disturbance-related lesions (n=89; mesenteric arterial thrombosis and nonocclusive lesions [1,14,15,16,27]), ulcerative lesions (n=46), pseudomembranous colitis (n=10), neutropenic colitis (n=18) [6], inflammatory bowel disease (n=2; classified as ulcerative colitis, Crohn's disease), and amyloidosis (n=1). Bacterial and/or fungal infection was noted in the mucosa in some cases and was accompanied by distinct neutrophilic infiltration and/or mucosal injuries.…”