title: Histopathology and microbiology of isolated rectal bleeding in neonates: the so-called 'ecchymotic colitis'.
abstract: Rectal bleeding in neonates is an alarming event which suggests a possible necrotizing enterocolitis (NEC) but is usually the only symptom of an unexplained colitis characterized endoscopically by ecchymotic mucosal lesions, the so-called 'ecchymotic colitis' (EC). We studied histologically and bacteriologically 18 infants (mean age: 18 days) presenting with rectal bleeding by systematic rectosigmoidoscopy and intestinal biopsies. The 18 infants were hospitalized. Prematurity was found in seven cases and an underlying condition in 14 cases (respiratory distress: six cases; infection: six cases; surgery: two cases). Histology showed a mild to moderate inflammation (10/12) of the mucosa with a prevalence of polymorphonuclear cells (8/10), frequent focal haemorrhages (11/12) and foci of pneumatosis (4/12). Numerous bacteria were seen in the mucus layer focally forming large clusters. Cultures of intestinal biopsies yielded exclusively Enterobacteriaceae species: Escherichia coli (seven cases), Klebsiella spp. (seven cases), and Enterobacter cloacae (three cases); four cases were sterile. Our study demonstrates that neonatal bleeding is associated with endoscopic and histological 'ecchymotic colitis' lesions and with a peculiar microbial flora of EBC strains. EC and necrotizing enterocolitis share similar features raising the question of the link between the two syndromes.
authors.affiliation: Department of Pathology, Hôpital Necker-Enfants-Malades, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Canioni
authors.forename: S
authors.initials: S
authors.lastname: Pauliat
authors.forename: J L
authors.initials: JL
authors.lastname: Gaillard
authors.forename: J F
authors.initials: JF
authors.lastname: Mougenot
authors.forename: Y
authors.initials: Y
authors.lastname: Bompard
authors.forename: P
authors.initials: P
authors.lastname: Berche
authors.forename: J
authors.initials: J
authors.lastname: Schmitz
authors.forename: N
authors.initials: N
authors.lastname: Brousse
mesh_terms: D001706:Biopsy; D003093:Colitis, Ulcerative / Q000382:microbiology* / Q000473:pathology; D004438:Ecchymosis / Q000382:microbiology* / Q000473:pathology; D004756:Enterobacteriaceae Infections / Q000175:diagnosis; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D012812:Sigmoidoscopy