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Multiple intestinal ulcerations and perforations secondary to methicillin-resistant Staphylococcus aureus enteritis in infants

 Seok Joo Han  ;  Poong Man Jung  ;  Hoguen Kim  ;  Jai-Eok Kim  ;  Jeong Hong  ;  Eui Ho Hwang  ;  Inwha Seong 
 Journal of Pediatric Surgery, Vol.34(3) : 381-386, 1999 
Journal Title
 Journal of Pediatric Surgery 
Issue Date
Anti-Bacterial Agents/therapeutic use ; Enterocolitis, Necrotizing/complications* ; Enterocolitis, Necrotizing/drug therapy ; Enterocolitis, Necrotizing/microbiology ; Female ; Humans ; Infant ; Intestinal Perforation/etiology* ; Intestinal Perforation/surgery ; Intestine, Small/surgery ; Male ; Methicillin Resistance ; Staphylococcal Infections/complications* ; Staphylococcal Infections/drug therapy ; Ulcer/etiology* ; Ulcer/surgery ; Vancomycin/therapeutic use
PURPOSE: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. METHODS: Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean Association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically. RESULTS: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of Gram-positive cocci. (4) Methicillin-resistant Staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived. CONCLUSIONS: This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hogeun(김호근)
Han, Seok Joo(한석주) ORCID logo https://orcid.org/0000-0001-5224-1437
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