Goldszmidt D, Duché M, Gauthier F
Département de pédiatrie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Arch Pediatr. 1994 Nov;1(11):1011-3.
Ileal ulcers can be seen several years after surgery for neonatal necrotizing enterocolitis. They may be due to chronic bacterial colonisation of the intestine.
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.
Chronic bacterial colonization can be responsible for ileal ulcers several years after intestinal resection, requiring a prolonged controlled follow-up.
