eP254 A rare case of adult necrotising enterocolitis requiring emergency subtotal colectomy

Introduction Clostridium Perfringens is a gram-positive anaerobic bacillus which can cause a spectrum of acute diarrhoeal, food-borne diseases secondary to enterotoxin release. Usually the disease is self-limiting in adults, but can cause necrotising enterocolitis (NEC) in premature neonates and certain developing countries. We present a rare case of NEC secondary to Clostridium Perfringens in an adult patient. Case Presentation A female in her 70s presented with acute abdominal pain and diarrhoea after consuming a takeaway sausage and bean pasty. She was independent and had a history of hypertension, chronic kidney disease, ischaemic heart disease, hypothyroidism and hysterectomy. She was severely septic on admission, with CT evidence of colitis and colonic dilatation. She deteriorated clinically despite antibiotic therapy and organ support on ITU. Subsequently on Day 5, the patient underwent emergency laparotomy, subtotal colectomy, end ileostomy and emergency splenectomy. Intraoperative findings included patchy colonic necrosis and intestinal pneumatosis. Adult NEC was diagnosed histologically in the context of positive Clostridium Perfringens stool culture. The patient survived and was discharged home after 64 days. Discussion Treatment for Clostridium Perfringens disease is usually supportive. Rarely, surgical intervention is required if there is clinical suspicion of intestinal necrosis, perforation or refractory sepsis despite a period of intensive care support. Intestinal pneumatosis is a pathognomonic feature of NEC. In such patients, there should be a low threshold for emergency laparotomy. Conclusion Although adult NEC is rare, recognition of the role of early surgical intervention in these patients with severe Clostridium Perfringens infection is key to survival.