Acute Hemorrhage and Necrosis of the Intestines

ENTEROCOIJTIS is a rather common entity seen often in a variety of forms by the clinician and the pathologist. There have been four reports of special types of gastrointestinal lesions in the patient with cardiovascular disease. Kleckner et al.' reported two cases of cardiac disease with acute pseudomembranous enterocolitis. Wilson and Qualheim2 described a form of acute hemorrhagic enterocolitis afflicting chronically ill individuals. They considered this to be unlike acute pseudomembranous colitis. Seventeen of their 20 cases had chronic cardiovascular disease. Ende3 described infarction of the bowel in cardiac failure in six cases. Recently, Katz4 described a hemorrhagic duodenitis in myocardial infarction. During the past 10 years we have observed, clinically and at autopsy, 10 cases of acute hemorrhage and necrosis of the bowel in patients with cardiac disease. In one additional case no autopsy was obtained but similar pathologic lesions were seen at laparotomy. Although the etiology is not apparent, it is of interest that all these patients had received large amounts of digitalis and several were in digitalis toxicity. Digitalization is considered as the main associated factor in these cases, especially since there was no mesenteric arterial involvement and only venous engorgement.