Proximal Enteritis–Jejunitis This poorly understood disease affects the proximal portion of the small intestine and has various names including proximal enteritis–jejunitis, anterior enteritis, and duodenitis–jejunitis. The condition has been recognized in the southeastern and northeastern USA, England, and on the European continent. The cause is unknown. The affected intestine contains lesions varying from hyperemia to necrosis and infiltration of the submucosa with inflammatory cells. Often, there is edema and hemorrhage in the various layers of the intestinal wall. Varying degrees of abdominal pain, ranging from mild to severe, are characteristic. When the prevalence of the condition peaked in the 1980s, it was characterized by voluminous amounts of gastric reflux, progression from pain to depression, and moderate to severe distention of the small intestine on rectal examination. In addition, the distended duodenum often was palpated as it coursed around the base of the cecum. The peritoneal fluid often contained an increased concentration of protein (>3 g/dL) with a normal number of WBC, but this finding did not consistently distinguish the condition from other causes of small-intestinal disease. Based on anecdotal reports, the prevalence and clinical severity of the condition have decreased in the past decade, at least in regions of the country where the condition characteristically had a more severe course and was accompanied by a high incidence of laminitis. Treatment may be either medical or surgical. Medical treatment includes continued gastric decompression until the gastric reflux abates, IV fluids, and analgesics, as required. Many clinicians administer penicillin and low doses of flunixin meglumine; some also administer neostigmine, lidocaine, or metoclopramide to stimulate small-intestinal motility. Some surgeons, particularly in the UK, believe exploratory laparotomy and intestinal decompression result in a more rapid recovery. The survival rate associated with proximal enteritis–jejunitis is reported to be 44%. The feet should receive particular attention because acute laminitis has been reported as a common complication, with a prevalence of ∼25%.
Posted on: Thu, 22 Aug 2013 22:20:12 +0000
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