J Korean Surg Soc.  2004 May;66(5):430-434.

Segmental Ischemia of the Small Bowel Caused by Cytomegalovirus Infection in a Patient with Multiple Injuries after a Traffic Accident

• Park KC
• Jang HJ
• Cho YP
• Kim YH
• Jung SM
• Park YS
• Han MS

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.

Keyword

Cytomegalovirus (CMV); CMV enteritis; Segmental ileal ischemia; Traffic accident

MeSH Terms

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
Ganciclovir