| Clinical Study of Multiple Intestinal Ulcerations and Perforations Caused by Methicillin-Resistant Staphylococcus aureus in Infants |
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Seok Joo Han1, Poong Man Jung2, Jai-Eok Kim3, Jeong Hong4, Hoguen Kim5, Inwha Seong6, Eui Ho Hwang1 |
1Department of Pediatric Surgery, College of Medicine, Yonsei University, Seoul, Korea
2Department of Pediatric Surgery Service, College of Medicine, Hanyang University, Seoul, Korea
3Department of Pediatric Surgery, Sowha Children Hospital, Seoul, Korea
4Department of Surgery, College of Medicine, Ajou University, Korea
5Department of Pathology, College of Medicine, Yonsei University, Seoul, Korea
6Department of Microbiology, College of Medicine, Korea University, Seoul, Korea |
| 영아에서 발생한 메티실린 저항성 포도상구균에 의한 다발성 장궤양 및 장천공에 대한 임상 연구 |
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한석주1, 정풍만2, 김재억3, 홍정4, 김호근5, 성인화6, 황의호1 |
1연세대학교 의과대학 외과학교실 소아외과
2한양대학교 의과대학 외과학교실 소아외과
3소화아동병원 소아외과
4아주대학교 의과대학 외과학교실 소아외과
5연세대학교 의과대학 병리학교실
6고려대학교 의과대학 미생물학교실 |
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| Abstract |
Purpose
: In recent years, the authors experienced a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. The purpose of this study was to describe the clinical characteristics of this entity, examine th possible pathogenesis and the effective treatment.
Methods
: Seven infants underwent abdominal exploration under suspicion of surgical abdomen and were noted to have multiple intestinal ulcerations and perforations without evidence of necrotizing enterocolitis by the members of the Korean Association of Pediatric Surgeons. The clinical courses, operative findings, bacterial cultures, pathologic findings, treatment and prognosis of these seven cases were evaluated retrospectively.
Results
: The characteristics of this entity are as follows : The initial presenting symptoms were all different. Despite conservative treatment with a broad spectrum of antibiotics, diarrhea and abdominal distention developed and progressively grew worse. At laparotomy, all patients exhibited numerous typical transverse linear ulcerative lesions with pin-point perforations scattered mainly in the small bowel. Histologic evaluations of the resected specimens revealed mucosal ulcerations with neutrophil infiltration, submucosal microabscesses and colonies of gram-positive cocci. Methicillin-resistant Staphylococcus aureus(MRSA) was the predominant organism cultured from the body fluid. Only two cases, the completely-resected one and the one immediately treated with vancomycin after operation, survived.
Conclusion
: We think this distinct clinical entity exhibiting multiple intestinal ulcerations and perforations is caused by MRSA occurring in infants. It has a high mortality because it is very difficult to diagnosis in young infants before laparotomy. Vancomycin is highly effective in treating MRSA, so we think the early diagnosis of this entity can make the treatment successful. |
| Key Words:
Methicillin-resistant Staphylococcus aureus(MRSA), Intestinal ulceration, Intestinal perforation, Vancomycin |
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