SCANNING ELECTRONMICROSCOPY OF THE JEJUNUM IN ENTERITIS NECROTICANS

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Abstract
An Epidemic form of enteritis necroticans, locally known as pig-bel, occurs in children in the highlands of Papua New Guinea (Murrell and Roth, 1963; Murrell et al., 1966a). The disease is a serious public-health problem with an annual mortality of about 14 per 10,000 population (Murrell et al., 1966b). It is now the commonest cause of death in Eastern Highland Hospitals among children over 1 year of age and it is estimated that approximately 750 children die from pig-bel each year. Evidence suggests that the condition is precipitated by the growth of strains of Clostridium perfringens type C (Egerton and Walker, 1964) present in small numbers in the normal intestinal flora or ingested with contaminated meat during pig feasting, with subsequent production of β toxin leading to segmental paralysis, inflammation and necrosis of the small intestine. The normal low-protein diet, the staple sweet potato, a dietary change to meat particularly during pig feasting, and low levels of β antitoxin in those at risk are thought to be predisposing factors in the pathogenesis of this gangrenous enteritis (Lawrence and Walker, 1976). Only small amounts of pancreatic protease, particularly trypsin which is known to destroy β toxin, are produced by children on a low-protein diet; this, coupled with the presence of trypsin inhibitors in semi-cooked sweet potato, may be of particular importance (Lawrence, 1974, 1975).