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Journal of Tropical Pediatrics 2002 48(2):88-92; doi:10.1093/tropej/48.2.88
© 2002 by Oxford University Press
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Angiographic and Immunologic Studies in Acute Necrotizing Jejunoileitis

V. V. S. S. Chandrasekharam1, D. N. Srivastava2, M. Mathur3 and V. Bhatnagar1

1 The Departments of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India 2 The Departments of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi-110029, India 3 The Departments of Pathology, All India Institute of Medical Sciences, New Delhi-110029, India

Eighteen cases of laparotomy-proven acute necrotizing jejunoileitis were treated during the period 1992–1998. Routine laboratory investigations and bacteriological studies were non-contributory towards establishing an etiological basis for the diagnosis. Superior mesenteric artery digital subtraction angiography, carried out in five patients, demonstrated extensive neovascularization. IgG, IgM and IgA were normal in all eight children in whom it was measured; IgE levels were grossly elevated (mean 900 IU/ml; normal range 0–100 IU/ml). Four cases had evidence of hypersensitivity reactions (type I in one patient and type III in three patients) on histopathological examination of the resected small bowel. In addition, histopathological examination also showed the neovascularization observed on angiography. The evidence suggests an immunologically mediated insult resulting in intense vasculitis, which in turn causes ischemic damage to the bowel wall.


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