Tuberculosis of the rectum in a patient with acquired immune deficiency syndrome

Tuberculosis of the rectum is a rare disease. A patient with a miliary pattern of pulmonary tuberculosis had a rectal lesion which proved to be tuberculosis. The patient subsequently developed several opportunistic infections characteristic of acquired immune deficiency syndrome. The clinical, endoscopic, radiologic, and histologic findings of this treatable lesion are presented.     

Differentiation of food protein-induced enterocolitis syndrome and necrotizing enterocolitis in neonates by abdominal sonography

ObjectivesTo summarize and differentiate abdominal ultrasound findings of necrotizing enterocolitis and food protein-induced enterocolitis syndrome.MethodsFrom January 2017 to December 2018, the abdominal ultrasound results of 304 cases diagnosed necrotizing enterocolitis or food protein-induced enterocolitis syndrome were retrospectively analyzed. The presence of pneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility, focal fluid collections and hypoechoic change of gallbladder wall were calculated, and the results were compared and analyzed.ResultsPneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility weakened/absent, focal fluid collections and hypoechoic change of gallbladder wall can be found in both necrotizing enterocolitis and food protein-induced enterocolitis syndrome infants. However, in infants with necrotizing enterocolitis, intestinal motility was weakened/absent in whole abdomen, and in food protein-induced enterocolitis syndrome, it only involved isolated segment of bowel. The positive rates of above signs in necrotizing enterocolitis infants were significantly higher than those in food protein-induced enterocolitis syndrome (p < 0.01). Moreover, it was observed that the rate of weakened intestinal motility besides the lesion segment of bowel in necrotizing enterocolitis infants was 100%, and in food protein-induced enterocolitis syndrome infants, it was 0%, which is supposed to be a main sign for identification.ConclusionIn the early stage, abdominal ultrasound can be used to differentiate necrotizing enterocolitis and food protein-induced enterocolitis syndrome.     

Persistence of enterocolitis following diversion of faecal stream in Hirschsprung's disease

Mucosal defence mechanisms of the excluded bowel were studied in 12 patients with Hirschsprung's disease. The entire resected segment of colon obtained following Swenson's operation was cut at 0.5-cm intervals and serially examined by routine haematoxylin and eosin staining, immunocytochemistry, and mucin histochemistry. Seven patients who had clinical evidence of enterocolitis prior to defunctioning colostomy showed histological and immunological evidence of enterocolitis (crypt abscesses, ulceration, leucocyte aggregation, Paneth cell metaplasia, and marked immunocyte responses) in the excluded bowel even several months after diversion of the faecal stream. Mucin histochemistry showed marked depletion of neutral mucins and sulphomucins in the excluded bowel with inflammatory changes and reversal of the sialo- to sulphomucin ratio. These results indicate that patients with enterocolitis complicating Hirschsprung's disease have persistent inflammatory changes in the excluded large bowel after diversion of the faecal stream by colostomy. Environmental factors such as bacterial stimulation and proliferation probably cause inhibition of cell renewal, resulting in abnormalities of mucin fractions. Changes in mucin composition, which is an important mechanical and chemical factor of the mucosal defence mechanism, may lead to altered susceptibility to bacterial degradation and hence may be important in the pathogenesis of enterocolitis. Offprint requests to: P. Puri     

Cytomegalovirus enterocolitis in a patient with diffuse large B-cell lymphoma after chemotherapy with rituximab

TO THE EDITOR In response to Unluturk et al ’s letter to the editor entitled ‘Cytomegalovirus gastritis after rituximab treatment in a non-Hodgkin’s lymphoma patient[1], a similar case of cy- tomegalovirus (CMV) enterocolitis after treatment with ritux…     

新生儿坏死性小肠结肠炎防治的研究进展

新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)是新生儿较常见的胃肠道疾病,是早产儿死亡的主要原因,其发病机制目前尚不明确.近年来,国内外学者对NEC的危险因素、发病机制、治疗及预防作了大量的深入研究,试图从喂养方式、微生态制剂的应用、病原菌感染的控制、营养因子或细胞因子的干预等手段来减少NEC的发病率和病死率.     

新生儿坏死性小肠结肠炎防治的研究进展

新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)是新生儿较常见的胃肠道疾病,是早产儿死亡的主要原因,其发病机制目前尚不明确.近年来,国内外学者对NEC的危险因素、发病机制、治疗及预防作了大量的深入研究,试图从喂养方式、微生态制剂的应用、病原菌感染的控制、营养因子或细胞因子的干预等手段来减少NEC的发病率和病死率.     

Aeromonas aquariorum septicemia and enterocolitis in a cirrhotic patient

Aeromonas aquariorum is a recently described Aeromonas species. We present a cirrhotic patient with septicemia and bloody diarrhea in whom A. aquariorum was isolated from the blood and stool. The species identification was based on sequence analysis of the partial rpoB and rpoD genes. The A. aquariorum isolates carried genes encoding hemolysin, aerolysin, and the cytotonic enterotoxin Alt. Significant A. aquariorum–induced cytotoxicity in intestinal epithelial cells was also demonstrated.     

Decreased Incidence of Hirschsprung-Associated Enterocolitis During COVID-19 Across United States Children's Hospitals

BackgroundThe Coronavirus Disease 2019 pandemic provided a natural experiment to study the effect of social distancing on the risk of developing Hirschsprung's Associated Enterocolitis (HAEC).MethodsUsing the Pediatric Health Information System (PHIS), a retrospective cohort study of children (<18 years) with Hirschsprung's Disease (HSCR) across 47 United States children's hospitals was performed. The primary outcome was HAEC admissions per 10,000 patient-days. The exposure (COVID-19) was defined as April 2020–December 2021. The unexposed (historical control) period was April 2018–December 2019. Secondary outcomes included sepsis, bowel perforation, intensive care unit (ICU) admission, mortality, and length of stay.ResultsOverall, we included 5707 patients with HSCR during the study period. There were 984 and 834 HAEC admissions during the pre-pandemic and pandemic periods, respectively (2.6 vs. 1.9 HAEC admissions per 10,000 patient-days, incident rate ratio [95% confidence interval]: 0.74 [0.67, 0.81], p < 0.001). Compared to pre-pandemic, those with HAEC during the pandemic were younger (median [IQR]: 566 [162, 1430] days pandemic vs. 746 [259, 1609] days pre-pandemic, p < 0.001) and more likely to live in the lowest quartile of median household income zip codes (24% pandemic vs. 19% pre-pandemic, p = 0.02). There were no significant differences in rates of sepsis (6.1% pandemic vs. 6.1% pre-pandemic, p > 0.9), bowel perforation (1.3% pandemic vs. 1.2% pre-pandemic, p = 0.8), ICU admissions (9.6% pandemic vs. 12% pre-pandemic, p = 0.2), mortality (0.5% pandemic vs. 0.6% pre-pandemic, p = 0.8), or length of stay (median [interquartile range]: 4 [(Pastor et al., 2009; Gosain and Brinkman, 2015) 2,112,11 days pandemic vs. 5 [(Pastor et al., 2009; Tang et al., 2020) 2,102,10 days pre-pandemic, p = 0.4).ConclusionsThe COVID-19 pandemic was associated with significantly decreased incidence of HAEC admissions across US children's hospitals. Possible etiologies such as social distancing should be explored.Level of evidenceII.