Segmental Ischemia of the Small Bowel Caused by Cytomegalovirus Infection in a Patient with Multiple Injuries after a Traffic Accident.
- Author:
Kil Chun PARK
1
;
Hyuk Jai JANG
;
Yong Pil CHO
;
Yong Ho KIM
;
Seung Mun JUNG
;
Yang Soon PARK
;
Myeng Sik HAN
Author Information
1. Department of Surgery, Ulsan University College of Medicine and Asan Medical Center, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Cytomegalovirus (CMV);
CMV enteritis;
Segmental ileal ischemia;
Traffic accident
- MeSH:
Abdominal Pain;
Accidents, Traffic*;
Acquired Immunodeficiency Syndrome;
Appendix;
Cytomegalovirus Infections*;
Cytomegalovirus*;
Diarrhea;
Enteritis;
Fever;
Ganciclovir;
Gastrointestinal Tract;
Hemorrhage;
Humans;
Ileum;
Incidence;
Inclusion Bodies;
Inflammatory Bowel Diseases;
Ischemia*;
Melena;
Middle Aged;
Mortality;
Multiple Trauma*;
Ulcer
- From:Journal of the Korean Surgical Society
2004;66(5):430-434
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Cytomegalovirus infections (CMV) of the gastrointestinal tract (GI) are common, and most often seen in patients with acquired immunodeficiency syndrome (AIDS), inflammatory bowel disease, or those receiving immunosuppressive therapy. CMV enteritis is uncommon in an immunocompetent individual. A CMV infection of the small bowel accounts for 4.3% of all CMV infections of the GI tract. The GI manifestations of CMV include: diarrhea, bleeding, obstruction and perforation, all of which are usually secondary to discrete erosions or ulceration. High mortality rates have been reported for CMV enteritis. Here, a rare case of CMV enteritis, resulting in segmental ileal ischemia, is reported in a 47-year old man following a traffic accident. On the 17th hospital day, he developed melena, watery diarrhea, fever and abdominal pain. An abdominal computed tomography (CT) on the 23rd hospital day showed an enlarged appendix with mild periappendiceal infiltration and segmental wall thickening in the terminal ileum. An ileocecal resection was performed. Pathological evaluation of the operative specimen revealed CMV inclusion bodies, with ulcerations. The patient was treated with ganciclovir therapy for 3 weeks after which his symptoms improved. If a CMV infection is highly suspected in multiply injured trauma victims, the earlier recognition of potential small bowel involvement can hopefully decrease the incidence of bleeding, ischemic demage to the bowel and perforation, which are usually fatal events.
