ABSTRACT
Objective To analyze the characteristics of Behcet's disease (BD) with intestinal lesions to provides further reference for the diagnosis and treatment.Methods Four hundred and one cases of BD patients' data were collected including basic data,colonoscopy report,pathology diagnosis and hematologic examination.Statistical description of intestinal lesions was applied and analyzed for the differences between the locations and blood examinations of intestinal lesions.Results Within these 401 BD patients,88 (21.95 ％) with intestinal lesions.Intestinal ulcerations,including both active and inactive phase,appeared in 52 cases (12.97％) mostly founded in ileocecum,in which 62.86％ (22/ 401,5.49％ of all BD patients) without the abdominal discomfort.Compared with inactive phase,the active phase intestinal BD patients have higher inflammation indexes with C reactive protein (CRP) increased of statistical significance (P =0.028).Thirty-three cases (8.23 ％) with adenomas were founded,including tubular adenoma,serrated adenoma and villous adenoma.Mostly occurred in rectum,sigmoid colon,especially the sigmoid colon rectum junction.Adenomas were seen in eider patients with statistical significance compared to BD patients without intestinal lesion or with intestinal ulceration (P =0.022,0.000),and exhibited elder changes of lab tests,such as increas in aspartate aminotransferase (AST),gamma-glutamyl transferase (GGT) and uric acid (UA).In addition,2 cases of melanosis coli and 1 case of caecal diverticulum were also founded.Conclusions BD patients with intestinal ulcer or adenoma takes a fairly high ratio,and most intestinal BD and BD with adenoma patients did not complaint related symptoms,so colonoscopy as a screening method for diagnosis and treatment of BD is necessary.
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 verydifficult 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.
Subject(s)
Humans , Infant , Abdomen , Anti-Bacterial Agents , Body Fluids , Diagnosis , Diarrhea , Early Diagnosis , Enterocolitis, Necrotizing , Gram-Positive Cocci , Intestinal Perforation , Laparotomy , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Mortality , Neutrophil Infiltration , Prognosis , Retrospective Studies , Staphylococcus , Ulcer , VancomycinABSTRACT
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 verydifficult 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.