**Question:** A newborn presented with bloated abdomen sholy after birth with passage of less meconium. A full thickness biopsy of the rectum was carried out. Which one of the following rectal biopsy findings is most likely to be present?

A. Mucosal edema
B. Increased goblet cell density
C. Submucosal edema
D. Increased inflammatory cell infiltrate

**Correct Answer:**

**Core Concept:** In a newborn with bloated abdomen and less meconium passage, the most likely rectal biopsy finding to be present is **D.** Increased inflammatory cell infiltrate.

**Why the Correct Answer is Right:**

In this scenario, the newborn's presentation suggests that there may be an obstruction or mechanical issue causing the bloated abdomen and reduced meconium passage. The presence of increased inflammatory cell infiltrate (white blood cells) in the biopsy sample indicates inflammation or irritation within the rectal mucosa and submucosa. This inflammation is likely due to the mechanical obstruction or other factors causing the newborn's symptoms.

**Why Each Wrong Option is Incorrect:**

A. Mucosal edema (option A) could be present in some cases, but it is not specific to the presented scenario. Inflammatory cell infiltrate is more indicative of the issue at hand.

B. Increased goblet cell density (option B) is related to the production and release of mucus, which is not directly linked to the presented clinical signs and symptoms.

C. Submucosal edema (option C) is a less specific finding compared to increased inflammatory cell infiltrate, as the latter addresses the primary issue of inflammation and obstruction.

E. Increased smooth muscle cells (option D) is not directly related to the clinical manifestations described, as the focus should be on inflammation or obstruction, which inflammatory cell infiltrate addresses.

**Clinical Pearl:** Rectal biopsy findings can provide valuable information in assessing the cause of neonatal bowel obstruction symptoms. In this case, increased inflammatory cell infiltrate is the key finding that helps identify the cause of the newborn's symptoms and guides further management.