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July 1964

Hemorrhagic Necrosis of the IntestineA Clinical Syndrome: Presence Without Organic Vascular Occlusion

Arch Surg. 1964;89(1):42-53. doi:10.1001/archsurg.1964.01320010044006

Introduction  Extensive hemorrhagic necrosis of the bowel mucosa without associated mesenteric vascular occlusion is a characteristic feature of dogs dying of shock.1-3 While this is a recognized feature of endotoxin,4-7 adrenalin,8-10 or hemorrhagic11,12 shock in dogs, it is notably absent in humans dying of hypovolemic shock. Consequently it was thought interesting to observe seven patients, within the space of two years, who were found either at the time of laparotomy or at autopsy to have hemorrhagic necrosis of the bowel without demonstrable occlusion in the mesenteric vessels.No completely satisfactory explanation exists regarding the characteristic hemorrhagic necrosis of mucosa associated with experimental shock. However, the remarkable similarity between the intestinal lesions of man and the dog suggested that they may have a common pathogenesis.

Case Material  Briefly the cases that constitute this study are summarized in Tables 1 and 2.An 84-year-old white male was admitted