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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Enterohemorrhagic E coli Colitis

Definition

  • Inflammation of the colon due to E coli O157:H7

Alternate/Historical Names

  • Verocytotoxin (verotoxin) producing E coli colitis

Diagnostic Criteria

  • Superficial necrosis of colonic mucosa
    • Preservation of base of crypts
      • Have been termed atrophic microcrypts
    • Necrotic material may form microscopic pseudomembrane
      • Does not form endoscopic pseudomembrane
  • Superficial mucosal hemorrhage and edema
  • Capillary thrombosis frequently prominent
  • Neutrophils in lamina propria and cryptitis may be present
  • E coli O157:H7 identified by culture
  • More severe in right colon and cecum
  • Clinically presents with abrupt onset of bloody diarrhea 3-4 days following ingestion
    • May be associated with hemolytic uremic syndrome or thrombocytopenia purpura

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting : November 11, 2009

Differential Diagnosis

  • Colitis due to E coli O157:H7 may be histologically indistinguishable from acute ischemia
    • Ischemia is usually localized
    • Clinical correlation and culture is necessary
    Acute Self-limited Colitis Enterohemorrhagic E coli Colitis
    Necrosis not typically seen Superficial mucosal necrosis
    Hemorrhage and thrombosis not typically seen Frequent hemorrhage and capillary thrombosis

    Pseudomembranous Colitis Enterohemorrhagic E coli Colitis
    Endoscopic pseudomembrane Pseudomembrane only microscopic
    Necrotic crypt epithelium erupts into lumen to form pseudomembrane Entire upper mucosal layer may slough into lumen to form pseudomembrane
    Hemorrhage is not prominent Prominent hemorrhage and capillary thrombosis
    C difficile titers elevated E coli O157:H7 identified by culture
    Associated with antibiotic therapy Not associated with antibiotic therapy

    Bibliography

    • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
    • Morandi E, Grassi C, Cellerino P, Massara PP, Corsi F, Trabucchi E. Verocytotoxin-producing Escherichia coli EH 0157:H7 colitis. J Clin Gastroenterol. 2003 Jan;36(1):44-6.
    • Griffin PM, Olmstead LC, Petras RE. Escherichia coli O157:H7-associated colitis. A clinical and histological study of 11 cases. Gastroenterology. 1990 Jul;99(1):142-9.
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