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Pathology of   Necrotizing Enteritis ("pigbel bel")

Dr Sampurna Roy MD





Clostridium perfringens Type C (an anaerobic gram-positive bacillus) also produces beta-enterotoxin, which causes a necrotizing enteritis known as "pig bel". Pig Bel.Perspect Pediatr Pathol. 1979;5:137-52


This necrotizing enteritis is seen in malnourished persons who have sudden dietary overindulgence, as was seen, for example, in impoverished children immediately after World War II.

Necrotizing enteritis is endemic in the highlands of New Guinea, especially in children who have participated in pig feasts. 

Most adults have circulating antibodies and do not develop pig bel. Spit roasting of pig carcasses eaten at the feasts encourages the growth of Clostridium perfringens.

The normal diet of the children is vegetarian, more than 90% of calories being derived from sweet potatoes.

The combination of inadequate protein consumption and the presence of a trypsin inhibitor in sweet potatoes renders the children deficient in intestinal proteases, to which beta-enterotoxin is very sensitive.

Usual incubation period is 48 hours after ingestion of contaminated meat.

The presenting symptoms include severe abdominal pain and distention, vomiting, and passage of bloody or black stool.

Patients with fulminating pig bel may die within 24 hours of onset.

Other patients have mild pig bel that resembles gastroenteritis.

Half of the patients require surgery.

Pathological features: Image Link

Necrotizing enteritis is a segmental disease that may be restricted to a few centimeters or may involve the entire small intestine.

Green, necrotic pseudomembranes are seen in segmental areas of necrosis and peritonitis.

More advanced lesions may perforate the bowel wall.

Histologic sections reveal infarction of the mucosa, with edema, hemorrhage, and suppurative infiltrate that extends transmurally.

The pseudomembrane is composed of necrotic epithelium containing gram-positive bacilli.

Further reading:

Clostridial enteritis necroticans versus secondary clostridial infection superimposed upon ischemic bowel disease.

Fatal enteritis necroticans (pigbel) in a diabetic adult.

Enteritis necroticans (pigbel) in a diabetic child.

Pigbel-like syndrome in a vegetarian in Oxford.

Clostridial disease of the gut.Clin Infect Dis. 1995 Jun;20 Suppl 2:S242-50.

Necrotizing enteritis simulating Pig-Bel disease in northern India.Indian J Gastroenterol. 1994 Oct;13(4):109-11.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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