Abstract
PURPOSE: The aim of this study was to describe our experiences of surgical removal of inflamed bowel in cytomegalovirus enterocolitis. METHODS: Eight homosexual males with a mean age of 41 years (range, 29–59 years) and a mean CD4 count of 21×10 6/1 (1–60× 106/1)with advanced human immunodeficiency virus infection and severe cytomegalovirus enterocolitis were treated with ileocecal resection (4 patients) or right-sided hemicolectomy (4 patients). Symptoms were lower abdominal pain, severe diarrhea, fever, and weight loss, unrelieved by anticytomegalovirus therapy. Radiologic examination showed that ulcerative inflammation was limited to the right colon and terminal ileum. Microscopic examination confirmed the cytomegalovirus enterocolitis. Intermittent cytomegalovirus treatment, usually with foscarnet for 10 to 14 days every 4 to 6 weeks was given postoperatively. RESULTS: Two minor postoperative complications occurred: a lesser wound infection and a moderate bleeding from the abdominal wound edges. One patient died after three weeks because of gastrointestinal bleeding from an ulcerating Kaposi's sarcoma lesion and another patient died from unrelated causes three weeks after discharge from the hospital. The remaining 6 patients experienced complete or partial palliation of the abdominal symptoms for a mean of 14 months (range, 5–35 months) until death or the end of observation time. One patient is still alive two years after the operation. The overall mean survival was 12 months (range, 0.5–35 months). Recurrent or persistent symptoms and/or signs of cytomegalovirus enterocolitis occurred in four patients after a mean of seven months. CONCLUSION: Resection of inflamed bowel combined with postoperative anticytomegalovirus treatment leads to excellent palliation and a relatively favorable survival in AIDS patients with cytomegalovirus enterocolitis.
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References
Gerna G, Parea M, Percivalle E,et al. Human cytomegalovirus viraemia in HIV-1-seropositive patients at various clinical stages of infection. AIDS 1990;44:1027–31.
Drew WL. Cytomegalovirus infection in patients with AIDS. J Infect Dis 1988;158:449–56.
Wexner SD, Smithy WB, Trillo C, Hopkins BS, Dailey TH. Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immunodeficiency syndrome. Dis Colon Rectum 1988;31:755–61.
Wilson SE, Robinson G, Williams RA,et al. Acquired immunodeficiency syndrome (AIDS), indications for abdominal surgery, pathology and outcome. Ann Surg 1989;210:428–34.
DeRiso AJ, Kemeny M, Torres RA, Oliver JM. Multiple jejunal perforations secondary to cytomegalovirus in a patient with acquired immunodeficiency syndrome. Dig Dis Sci 1989;34:623–9.
Tatum ET, Sun PC, Cohn DL. Cytomegalovirus vasculitis and colon perforation in a patient with the acquired immunodeficiency syndrome. Pathology 1989;21:235–8.
Kram HB, Shoemaker WC. Intestinal perforation due to cytomegalovirus infection in patients with AIDS. Dis Colon Rectum 1990;33:1037–40.
Wexner SD. Sexually transmitted diseases of the colon, rectum, and anus: the challenge of the nineties. Dis Colon Rectum 1990;33:1048–62.
Burke G, Nichols L, Balogh K. Perforation of the terminal ileum with cytomegalovirus vasculitis and Kaposi's sarcoma in a patient with acquired immunodeficiency syndrome. Surgery 1987;102:540–5.
Klatt EC, Shibata D. Cytomegalovirus infection in the acquired immunodeficiency syndrome. Arch Pathol Lab Med 1988;112:540–4.
Francis ND, Boylston AW, Roberts AHG, Parkin JM, Pinching AJ. Cytomegalovirus infection in gastrointestinal tract of patients with HIV-1 or AIDS. J Clin Pathol 1989;42:1055–64.
Dieterich DT, Rahmin M. Cytomegalovirus colitis in AIDS. Presentation in 44 patients and a review of the literature. J Acquir Immune Defic Syndr 1991;4(Suppl 1):29–35.
Meiselman MS, Cello JP, Margaretten W. Cytomegalovirus colitis. Gastroenterology 1985;88:171–5.
Hinnant KL, Rotterdam HZ, Bell ET, Trapper ML. Cytomegalovirus infection of the alimentary tract: a clinicopathological correlation. Am J Gastroenterol 1986;81:944–59.
Chachona A, Dieterich D, Krasinski K,et al. 9-(1,3-dihydroxy-2-propoxymethyl)guanine (ganciclovir) in the treatment of cytomegalovirus gastrointestinal disease with the acquired immunodeficiency syndrome. Ann Intern Med 1987;107:133–7.
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Söderlund, C., Bratt, G.A., Engström, L. et al. Surgical treatment of cytomegalovirus enterocolitis in severe human immunodeficiency virus infection. Dis Colon Rectum 37, 63–72 (1994). https://doi.org/10.1007/BF02047217
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DOI: https://doi.org/10.1007/BF02047217