A case of pneumatosis cystoides intestinalis associated with mrsa enteritis

Abstract

The case involved an 84-year-old man who had been transferred to our hospital for the purpose of undergoing gastrostomy after cerebral infarction. When he was examined, he had already developed MRSA enteritis and it was the third day after initiation of transluminal administration of VCM at another hospital. An abdominal plain X-P and ultrasonic study revealed intestinal emphysema from the ascending to transverse colons, intra-abdominal free air, and hepatic portal venous gas. There was no ascites, and perforation and necrosis of the intestines were unlikely from physical and blood biochemical findings. The most likely diagnosis was a pathologic condition associated with MRSA enteritis. Accordingly conservative therapy under management with TPN was started and symptoms were improved. Thereafter the patient developed bacteremia due to MRSA and CV catheter infection, but he recovered from them. PEG was performed after free air and intestinal emphysema had disappeared, and then he was transferred to another hospital.
Recently clinical cases of pneumatosis cystoides intestinalitis with intra-abdominal free air and hepatic portal venous gas have been increasingly reported, however, no cases of these diseases associated with MRSA enteritis have been reported as far as we could review. This case is thus reported here, together with a review of the literature.