An unusual form of alimentary tract ulceration in infants

Abstract

IT is generally agreed that the pathological findings in infantile ga,stroenteritis are inconstant and non-specific. Cooper (1937) states :-" It is recognized that the post-mortem fkdings sometimes show only slight evidence of pathological change in the various organs ". Hinden (1948) described the changes in 22 autopsies. There were no macroscopic lesions in 9 : in 10 the intestine showed thinning and ballooning with occasional ulceration of the mucous membrane. Fifty -five fatal cases occurred in the epidemic reported by Giles et al. (1949). The stomach was normal in 35 cases, it was dilated in 7, in 9 the mucosa was congested and in 11 there were submucous hsmorrhages. The small intestine was normal in 4 cases, in 28 there was a mild hypersmia only, 13 had submucous haemorrhages and ulceration occurred in 4. The large bowel was less frequently involved than the ileum, ulceration and hsmorrhages occurring in 10 cases.We have observed four cases, presenting clinically as gastroenteritis, in which prominent and characteristic lesions were found in the alimentary tract post mortem. The histological appearances of the lesions are different from any that we have found recorded in the literature. CILNIOAL FEATURESAll four patients died in the Victoria Hospital for Children, Tite Street, London, during the six months between the middle of July 1952 and the middle of January 1953. The youngest was aged three months and the oldest eleven months. The outstanding clinical features were diarrhea with vomiting, irregular pyrexia and weight loss. With the exception of case 2, the diarrhea bcgan after admission to hospital, 14, 6 and 11 days after admission in cases 1, 3 and 4 respectively. I n all four cases the disease progressed ruthlessly over a period ranging from 17 t o 28 days. During this time, sulphonamides, various antibiotics, vitamins, parenterel fluid therapy and other supportive measures were applied without any obvious effect on the couree of the disease. The tongue ulcers were not observed until the diarrhea had been present for a considerable time (table I). Although the clinical history suggested some form of gastroenteritis, no pathogenic organisms, including atypical Bact. GO& were isolated from the stools in any of the cases.

Disease of the small bowel in childhood

“…There was a mild hyperaemia of the small intestine in twentyeight, submucosal haemorrhages in thirteen and ulceration in four; the small bowel was normal in four children. Ulceration of the small bowel in gastroenteritis appears to be uncommon, but four such cases were described by Dexter & Gowing in 1954. The mucosal appearances of the entire length of small bowel at post-mortem can be studied by allowing the surface epithelium to slough off and the connective tissue 'cores' of the villi to be exposed and stained and then examined under the dissecting microscope (Walker-Smith, 1969a). Using this method of examination in seven children who died following the clinical syndrome of gastroenteritis at the Royal Alexandra Hospital for Children an abnormal appearance was observed in all.…”