1/18. Multiple intestinal ulcerations and perforations secondary to methicillin-resistant staphylococcus aureus enteritis in infants.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.- - - - - - - - - - ranking = 1keywords = enteritis (Clic here for more details about this article) |
2/18. Eosinophilic gastroenteritis presenting as obstructive jaundice.Eosinophilic gastroenteritis is a rare condition of unknown aetiology, first described by Kaijser in 1937. It is manifest by eosinophilic infiltration of the gastrointestinal tract and peripheral eosinophilia. patients have various clinical presentations depending on the region of the gastrointestinal tract involved and the depth and extent of the bowel wall involvement. Whereas gastrointestinal obstruction associated with this condition is not uncommon, isolated biliary obstruction has only been reported twice. We present a case of eosinophilic gastroenteritis with involvement of the biliary tract causing ulceration, fibrosis and obstruction. Although a rare condition, we believe the diagnosis of eosinophilic gastroenteritis should be entertained in patients with gastrointestinal symptoms and a peripheral eosinophilia who have no evidence of parasitic infection, vasculitis or neoplasms.- - - - - - - - - - ranking = 1.4keywords = enteritis (Clic here for more details about this article) |
3/18. Reactive angioendotheliomatosis of the intestine.We present a case of reactive angioendotheliomatosis (RAE) of the colon, featuring intravascular proliferation of endothelial cells with histologic resemblance to glomeruloid hemangioma. A 19-year-old Japanese male with an anal fistula was diagnosed endoscopically with Crohn's disease. Six months later, he was hospitalized for fever and abdominal pain. Emergency resection of ileocecum and splenic flexure of the colon was undertaken to control massive intestinal hemorrhage, and in all parts of the resected colon, foci of many small vessels with intravascular proliferation of endothelial cells were noted throughout the layers. Moreover, solid proliferation of endothelial cells was seen in the submucosa at the base of open ulcers. Two small granulomas, compatible with Crohn's disease, were also evident in the muscle layer of the terminal ileum. No other hemangiomas or hemangioma-like structures were observed with CT scans, and the vascular lesions were histologically diagnosed as RAE. The pathogenesis of this disorder is unknown, and most cases occur in skin with systemic disease. The present case might thus be a first case of RAE of the intestine without cutaneous involvement. Whether there is a relation with coexistent enteritis suggestive of Crohn's disease needs to be clarified.- - - - - - - - - - ranking = 0.2keywords = enteritis (Clic here for more details about this article) |
4/18. Epstein-Barr virus-associated enteritis with multiple ulcers after stem cell transplantation: first histologically confirmed case.The present case involves unique enteritis forming multiple ulcers associated with Epstein-Barr virus (EBV). A 57-year-old man had undergone a reduced intensity allogeneic stem cell transplantation for a relapse of multiple myeloma following sequential autologous peripheral blood stem cell transplantation. The ileum, resected for massive melena, showed multiple irregular ulcers with occasional cobblestone-like appearance. There was inflammation including numerous plasma cells in the ulcer bases and surrounding areas, where many EBV-infected plasma cells were detected by double staining with EBV-encoded small rna-1 (EBER-1) in situ hybridization and CD79a, while EBV-infected epithelial cells were not noted. The number of EBER-1-positive cells in the ileum (mucosa, 1451 cells/mm(2); submucosa, 465 cells/mm(2)) was much larger than in control samples (malignant lymphoma or leukemia after allogeneic stem cell transplantation, n = 4, range 0-113 cells/mm(2); malignant lymphoma after chemotherapy, n = 14, range 0-0.89 cells/mm(2); colon cancer, n = 12, range 0-3.5 cells/mm(2)). In the mucosa near the ulcers, EBER-1-positive cells often surrounded and involved the glandular epithelium, forming lymphoepithelial-like lesions. The histological findings differ from post-transplant lymphoproliferative disorders or intestinal thrombotic microangiopathy, and this is the first case of EBV-associated enteritis with ulcers characterized by numerous plasma cells and lymphoepithelial-like lesions after stem cell transplantation.- - - - - - - - - - ranking = 1.2keywords = enteritis (Clic here for more details about this article) |
5/18. Isolated cytomegalovirus ileitis detected by colonoscopy.cytomegalovirus infections in immunocompromised patients mimic graft-versus-host disease by causing abdominal pain, watery diarrhea, and protein-losing enteropathy. The cases of three bone marrow transplant patients with diarrheal illness and biopsy-proven graft-vs.-host disease are reported. Isolated cytomegalovirus enteritis was subsequently identified by endoscopic examination and biopsy of the terminal ileum. All three improved with the eventual institution of 9-(1,3-dihydroxy-2-propoxymethyl) guanine. Ileoscopy is important in addition to colonoscopy in bone marrow transplant patients with diarrhea if cytomegalovirus enteritis is to be identified and appropriately treated.- - - - - - - - - - ranking = 0.4keywords = enteritis (Clic here for more details about this article) |
6/18. churg-strauss syndrome (allergic granulomatous angiitis) with peculiar multiple colonic ulcers.We treated a 40-yr-old Japanese woman who had churg-strauss syndrome (CSS), as diagnosed by characteristic clinical features and histological findings; in addition, peculiar multiple colonic ulcers were seen during the course of her illness. Although gastrointestinal symptoms are often seen in CSS, there are few descriptions of lesions in the gastrointestinal tract. In the English literature, the gastrointestinal manifestations of CSS include eosinophilic gastroenteritis, but the mucosa is not usually ulcerated. On the other hand, Japanese cases are characterized by multiple ulcers which are considered to be caused by ischemia secondary to the vasculitis. Most of the reported cases have not been diagnosed until laparotomy or autopsy, and our case is the first with multiple ulcers throughout the entire colon as a complication of CSS.- - - - - - - - - - ranking = 0.2keywords = enteritis (Clic here for more details about this article) |
7/18. Ulcerative enteritis--atypical features.A 40 year old man with two month history of vomiting and weight loss, was found to have multiple strictures in his small bowel. Investigations outruled known causes of small bowel ulceration, and the flat bowel mucosa did not respond to a gluten free diet. Treatment with steroids conferred a temporary benefit, however, small bowel ulceration persisted.- - - - - - - - - - ranking = 0.8keywords = enteritis (Clic here for more details about this article) |
8/18. Diffuse intestinal ulceration after marrow transplantation: a clinicopathologic study of 13 patients.The cases of 13 allogeneic marrow transplant recipients who had undergone laparotomy for manifestations of severe enteritis were reviewed to determine the causes of the severe intestinal disease and to assess the relation between clinical, histologic, and microbiologic findings. Laparotomies were performed a median of 63 days (range, 11 to 273 days) after transplantation for suspected peritonitis, intestinal obstruction, or bleeding. Intestinal tissue was available from small bowel resections in nine patients, intraoperative biopsies in one, and from autopsies in three patients who died shortly after laparotomy. Widespread small bowel ulceration was present in all 13 cases. Four causes of ulceration were identified: chemoradiation toxicity (n = 2), acute graft-versus-host disease (GVHD) (n = 5), opportunistic infections superimposed on either GVHD or toxicity from chemotherapy (n = 4), and Epstein-Barr virus-associated lymphoproliferative disorder (n = 2). Intestinal infections, unrecognized before laparotomy, were due to cytomegalovirus (CMV), herpes simplex virus (HSV), adenovirus, and Torulopsis glabrata. CMV- and HSV-infected cells, often lacking diagnostic inclusions, were identified in the intestine by in situ hybridization with biotinylated dna probes. Eleven patients died in the perioperative period, and two died 452 and 558 days after surgery of complications of chronic GVHD. Poor outcomes were related to extensive intestinal involvement, which was commonly underestimated before surgery, failure to diagnose intestinal infections early, poor marrow function, impaired immunity, and refractoriness of severe GVHD.- - - - - - - - - - ranking = 0.2keywords = enteritis (Clic here for more details about this article) |
9/18. Idiopathic chronic ulcerative enteritis: a report of two cases.Idiopathic chronic ulcerative enteritis (ICUE) is considered by some physicians to be a variant of sprue. Two patients being treated at our hospital for nonspecific abdominal symptoms had abnormal findings from a small-bowel series; at surgery, an ulcerating process involving the jejunum was found. Clinical, radiological, and pathological findings in these cases suggest that ICUE is a distinct entity.- - - - - - - - - - ranking = 1keywords = enteritis (Clic here for more details about this article) |
10/18. campylobacter fetus ss. jejuni: a cause of massive lower gastrointestinal hemorrhage.A patient is described with Campylobacter enteritis complicated by massive lower gastrointestinal bleeding from multiple mucosal ulcers in the terminal ileum and at the ileocecal valve. Repeated stool cultures and antibiotic therapy may be indicated in certain patients to diminish the morbidity arising from what may seem to be mild disease. In patients who suffer bleeding complications, arteriography before surgery is necessary to demonstrate an otherwise grossly indefinable source of bleeding.- - - - - - - - - - ranking = 0.2keywords = enteritis (Clic here for more details about this article) |
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