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[Small intestine ulcers 12 years after ileosigmoid anastomosis for neonatal necrotizing enterocolitis]
D Goldszmidt1, M Duché, F Gauthier
1Département de pédiatrie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Chronic bacterial colonization can cause ileal ulcers years after neonatal necrotizing enterocolitis surgery. Prompt diagnosis and antibiotic treatment are crucial for managing these persistent ulcers and associated anemia.
Area of Science:
- Gastroenterology
- Pediatric Surgery
Background:
- Ileal ulcers are a potential long-term complication following surgery for neonatal necrotizing enterocolitis.
- Chronic bacterial colonization is a suspected cause of these late-onset ileal ulcers.
Observation:
- A 12-year-old boy presented with recurrent severe anemia, unresponsive to iron therapy.
- Endoscopic examination revealed inflammatory ileal ulcers near an anastomosis site from prior necrotizing enterocolitis surgery.
- Despite treatment with mesalazine and further surgery, ulcers and anemia recurred.
Findings:
- Breath hydrogen testing confirmed bacterial overgrowth in the small intestine.
- Treatment with metronidazole and amoxicillin led to a resolution of symptoms and anemia.
- This case highlights the link between bacterial overgrowth and ileal ulceration post-surgery.
Implications:
- Chronic bacterial colonization should be considered in patients with late-onset ileal ulcers after intestinal resection.
- Effective management may involve targeted antibiotic therapy for bacterial overgrowth.
- Prolonged follow-up is essential for patients with a history of necrotizing enterocolitis and subsequent ileal complications.
Background:
Ileal ulcers can be seen several years after surgery for neonatal necrotizing enterocolitis. They may be due to chronic bacterial colonisation of the intestine.
Case Report:
A 12 year-old boy admitted suffering from chronic severe anemia (hemoglobin 6.5 g/dl), hypochromic and microcytic. Digestive bleeding was negative and the patient was successfully given iron for 6 months. Anemia was found again several months after cessation of treatment. Rectosigmoidoscopy showed several ulcers with inflammatory mucosa, near anastomosis secondary to an extensive bowel resection due to necrotizing enterocolitis. Ulcers of the distal small bowel persisted despite mesalazine and iron therapy and required resection of the intestine on both sides of the anastomosis. A few months later, recurrence of both ulcers and anemia led to the search for bacterial overgrowth which was confirmed by breath hydrogen testing. The patient was then given metronidazole plus amoxicillin by alternate courses and is well one year later.
Conclusions:
Chronic bacterial colonization can be responsible for ileal ulcers several years after intestinal resection, requiring a prolonged controlled follow-up.