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Anorectal and colonic disease and the immunocompromised host

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Diseases of the Colon & Rectum

Abstract

The immunocompromised host is becoming increasingly ubiquitous in the authors' patient population. There are growing numbers of long-term transplant recipients, and combination chemotherapy is producing many long-term survivors. Of greatest concern is that the number of patients with human immunodeficiency virus (HIV) causing immunosuppression is increasing. The literature is reviewed to produce a current summary of conditions affecting the anorectum and colon and arising as a direct consequence of the immunocompromised host. Pathophysiology and theoretic considerations are mentioned where applicable and current therapy is discussed. The conditions are classified under infectious, neoplastic, iatrogenic, and congenital. Although the colorectal surgeon will encounter most of these conditions sometime during a career, many are infrequent, and a current review is provided herein to provide categorization and updated information.

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References

  1. Wexner SD, Smithy WB, Milsom JW, Dailey TH. The surgical management of anorectal diseases in AIDS and pre-AIDS patients. Dis Colon Rectum 1986;29:719–23.

    Article  PubMed  CAS  Google Scholar 

  2. Caterall RD. Sexually transmitted diseases of the anus and rectum. Clin Gastroenterol 1975;4:659–69.

    Google Scholar 

  3. Siegal FP, Lopez L, Hammer GS. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med 1981;305:1439–44.

    Article  PubMed  CAS  Google Scholar 

  4. Kalb RE, Grossman ME. Chronic perianal herpes simplex in immunocompromised hosts. Am J Med 1986;80:486–90.

    Article  PubMed  CAS  Google Scholar 

  5. Cone LA, Woodward DR, Potts BE, Byrd RG, Alexander RM, Last MD. An update on the acquired immunodeficiency syndrome (AIDS): associated disorders of the alimentary tract. Dis Colon Rectum 1986;29:60–4.

    PubMed  CAS  Google Scholar 

  6. Meiselman MS, Cello JP, Margaretten W. Cytomegalovirus colitis: report of the clinical, endoscopic and pathologic findings in two patients with the acquired immune deficiency syndrome. Gastroenterology 1985;88:171–5.

    PubMed  CAS  Google Scholar 

  7. Weber JN, Thom S, Bannison J, et al. Case report: cytomegalovirus colitis and oesophageal ulcerations in the context of AIDS: clinical manifestations and preliminary report of treatment with Foscarnet (phosphonoformate). Gut 1987;28:482–7.

    PubMed  CAS  Google Scholar 

  8. Burke G. Perforation of the terminal ileum with cytomegalovirus vasculitis and Kaposi's sarcoma in a patient with acquired immunodeficiency syndrome. Surgery 1987;102:540–5.

    PubMed  CAS  Google Scholar 

  9. Altman DF. Gastrointestinal cryptosporidiosis and cytomegalovirus enterocolitis. Front Radiat Ther Oncol 1985;19:88–90.

    PubMed  CAS  Google Scholar 

  10. Levinson W, Bennetts RW. Cytomegalovirus colitis in acquired immunodeficiency syndrome—a chronic disease with varying manifestations. Am J Gastroenterol 1985;80:445–7.

    PubMed  CAS  Google Scholar 

  11. Balthazar EJ, Megibow AJ, Fazzini E, Opolencia JF, Engal J. Cytomegalovirus colitis in AIDS: radiographic findings in 11 patients. Radiology 1985;155:585–9.

    PubMed  CAS  Google Scholar 

  12. Frager DH, Frager JD, Wolf EL. Cytomegalovirus colitis in acquired immune deficiency syndrome: radiologic spectrum. Gastrointest Radiol 1986;11:241–6.

    Article  PubMed  CAS  Google Scholar 

  13. Greyson-Fleg RT, Jones B, Fishman EK, Hamilton SR, Siegelman SS. Computed tomography findings in gastrointestinal involvement by opportunistic organisms in acquired immune deficiency syndrome. J Comput Tomogr 1986;10:175–81.

    Article  PubMed  CAS  Google Scholar 

  14. California Board of Medical Quality Assurance. Action report: AIDS a primer for the primary care practitioner. Pomerantz S, No. 34, March 1988:3–6.

    Google Scholar 

  15. Easkin OL. Gancyclovir for the treatment and suppression of serious infections caused by cytomegalovirus. Am J Med 1987; 83:201–7.

    Article  Google Scholar 

  16. Wexner SD, Major abdominal surgery in AIDS patients. 1987 Symposium on Colon and Rectal Diseases, Minneapolis, MN (unpublished data).

  17. Klein RS, Harris CA, Small CB, Moll B, Lesser M, Freidland G. Oral candidiasis in high-risk patients as the initial manifestation of the acquired immunodeficiency syndrome. N Engl J Med 1984;311:354–8.

    Article  PubMed  CAS  Google Scholar 

  18. Friedman A. Kaposi's sarcoma and the gastrointestinal tract: the San Francisco experience. Gastroenterology 1983;84:1160.

    Google Scholar 

  19. Howard HC, Paterson-Brown S, Weber JN, Chan ST, Harris JR, Glazer G. Squamous cell carcinoma of the anus in young homosexual men with T helper cell depletion. Genitourin Med 1986; 62:393–5.

    PubMed  CAS  Google Scholar 

  20. Daling JR, Weiss NS, Hislop TG, et al. Sexual practices, sexually transmitted diseases, and the incidence of anal cancer. N Engl J Med 1987; 317-973-7.

  21. Penn J. Cancers of the anogenital region in renal transplant recipients: analysis of 65 cases. Cancer 1986;58:611–6.

    Article  PubMed  CAS  Google Scholar 

  22. Vanden Heule B, Tayler CR, Terry R. Presentation of malignant lymphoma in the rectum. Cancer 1982;49:2602–7.

    Article  PubMed  CAS  Google Scholar 

  23. Loehr WJ, Mujahed Z, Zahn FD. Primary lymphoma of the gastrointestinal tract: a review of 100 cases. Ann Surg 1969;170:232–8.

    Article  PubMed  CAS  Google Scholar 

  24. Iochim HL, Copper MC, Hellman GC. Lymphomas in men at high risk for AIDS. Cancer 1985;56:2831–42.

    Article  Google Scholar 

  25. Iochim HL, Weinstein MA, Robbins RD, Sohn N, Lugo PN. Primary anorectal lymphoma: a new manifestation of the acquired immune deficiency syndrome (AIDS). Cancer 1987;60:1449–53.

    Article  Google Scholar 

  26. Coonley CJ, Straus DJ. Hodgkin's disease presenting with rectal symptoms. Cancer Invest 1984;2:279–84.

    PubMed  CAS  Google Scholar 

  27. Alt B, Glass NR, Sollinger H. Neutropenic enterocolitis in adults: a review of the literature and assessment of surgical intervention. Am J Surg 1985;149:405–8.

    Article  PubMed  CAS  Google Scholar 

  28. Ikard RW. Neutropenic typhlitis in adults. Arch Surg 1981;116:943–5.

    PubMed  CAS  Google Scholar 

  29. Shaked A, Shinar E, Freund H. Neutropenic typhlitis: a plea for conservatism. Dis Colon Rectum 1983;26:351–2.

    PubMed  CAS  Google Scholar 

  30. Dworkin B, Winawer SJ, Lightdale CJ. Typhlitis: report of a case with long-term survival and a review of the recent literature. Dig Dis Sci 1981;26:1032–7.

    Article  PubMed  CAS  Google Scholar 

  31. Varki AP, Armitage JO, Feagler JR. Typhlitis in acute leukemia: successful treatment by early surgical intervention. Cancer 1979;43:695–7.

    Article  PubMed  CAS  Google Scholar 

  32. Lea JW, Masys DR, Shackford SR. Typhlitis: a treatable complication of acute leukemia therapy. Cancer Clin Trials 1980;3:355–62.

    PubMed  Google Scholar 

  33. Mulholland MW, Delaney JP. Neutropenic colitis and aplastic anemia: a new association. Ann Surg 1983;197:84–90.

    PubMed  CAS  Google Scholar 

  34. Kies MS, Luedke DW, Boyd JF, McEve MJ. Neutropenic enterocolitis: two case reports of long-term survival following surgery. Cancer 1979;43:730–4.

    Article  PubMed  CAS  Google Scholar 

  35. Jablonski M, Putzki H, Heymann H. Necrosis of the ascending colon in chronic hemodialysis patients: report of three cases. Dis Colon Rectum 1987;30:623–5.

    PubMed  CAS  Google Scholar 

  36. Agger WA, Glasser JE, Mario Abellera R. Fatal necrotizing enterocolitis in a neonate with DiGeorge syndrome. Wis Med J 1984;83:16–8.

    PubMed  CAS  Google Scholar 

  37. Fisher JE, Khan AR, Heitlinger L, Allen JE, Afshani E. Case 3; chronic granulomatous disease of childhood with acute ulcerative colitis: a unique association. Pediatr Pathol 1987;7:91–6.

    Article  PubMed  CAS  Google Scholar 

  38. Jordan JM, Zizic TM, Dorsch CA. Possible pathogenetic role for ulcerative colitis in the arthritis, hepatomegaly, and erythema nodosum of common variable immunodeficiency. Johns Hopkins Med J 1982;151:54–8.

    PubMed  CAS  Google Scholar 

  39. Curzio M, Bernasconi G, Ceriani A, Sala G. Association of ulcerative colitis, sclerosing cholangitis, and cholangiocarcinoma in a patient with IgA deficiency. Endoscopy 1985;17:123–5.

    Article  PubMed  CAS  Google Scholar 

  40. Berlinger NT, Lopez C, Lipken M, Vogel JE, Good RA. Defective recognitive immunity in family aggregates of colon carcinoma. J Clin Invest 1977;59:761–9.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Ferguson Clinic, 75 Sheldon Blvd., S.E., 49503, Grand Rapids, Michigan

    Jace W. Hyder M.D. &  John M. MacKeigan M.D.

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  1. Jace W. Hyder M.D.
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  2. John M. MacKeigan M.D.
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Hyder, J.W., MacKeigan, J.M. Anorectal and colonic disease and the immunocompromised host. Dis Colon Rectum 31, 971–976 (1988). https://doi.org/10.1007/BF02554899

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