Related Experiment Videos
Multiple intestinal ulcerations and perforations secondary to methicillin-resistant Staphylococcus aureus enteritis
1Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea.
Insights
Infants treated with broad-spectrum antibiotics can develop severe MRSA enteritis, leading to intestinal perforations. Early diagnosis and vancomycin treatment are crucial for survival in this critical condition.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- A rare clinical entity of multiple intestinal ulcerations and perforations in infants was observed.
- This condition presented as a surgical emergency requiring abdominal exploration.
Observation:
- Infants affected typically had a history of broad-spectrum antibiotic treatment.
- Progressive diarrhea and abdominal distension were noted despite antibiotic therapy.
- Surgical findings revealed numerous transverse linear ulcerations throughout the small intestine.
Findings:
- Histopathology showed mucosal ulcers, submucosal microabscesses, and Gram-positive cocci.
- Methicillin-resistant Staphylococcus aureus (MRSA) was the predominant pathogen identified.
- High mortality was associated with this condition, with survival only in cases of complete resection or prompt vancomycin treatment.
Implications:
- This entity represents MRSA enteritis causing intestinal perforations in infants.
- Difficult diagnosis contributes to a high mortality rate.
- Early recognition and targeted vancomycin therapy are essential for improving patient outcomes.
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.