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Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome

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Diseases of the Colon & Rectum

Abstract

The charts of all patients with the acquired immune deficiency syndrome (AIDS) who underwent emergency intra-abdominal surgery between January 1981 and July 1987 were reviewed. Eleven AIDS patients underwent 13 emergency laparotomies. Seven of these patients (64 percent) had cytomegalovirus (CMV) ileocolitis as the pathologic process requiring emergent surgical intervention. Four patients had hemorrhagic CMV proctocolitis and three had perforations of CMV ulcers of the ileum or rectosigmoid. The operations performed included three subtotal colectomies, two segmental resections, and two diverting stomas. The postoperative mortality rate in the CMV group was 28 percent at one day, 71 percent at one month, and 86 percent at six months. Furthermore, CMV ileocolonic pathology was directly responsible for 70 percent of the deaths in AIDS patients who underwent emergent exploratory laparotomy.

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References

  1. Centers for Disease Control. AIDS weekly surveillance report. Atlanta, February 15, 1988.

  2. New York City Department of Health. AIDS Surveillance Unit. AIDS update. New York, January 15, 1988.

  3. Kristal AR. The impact of the acquired immune deficiency syndrome on patterns of premature death in New York City. JAMA 1986;255:2306–10.

    Article  PubMed  CAS  Google Scholar 

  4. New York City Department of Health. Bureau of Vital Statistics. 1986 Annual Report. New York, July 31, 1987.

  5. Centers for Disease Control. Update: AIDS in the U.S. MMWR 1986;35:17–21.

    Google Scholar 

  6. Centers for Disease Control. AIDS surveillance data. Atlanta, February 2, 1987.

  7. Coolfont Report: a Public Health Service plan for prevention and control of AIDS and the AIDS virus. Public Health Service Report 1986;101:341–8.

  8. DeVita VT, Hellman S, Rosenberg SA eds. AIDS: etiology, diagnosis, treatment, and prevention. Philadelphia: JB Lippincott, 1985.

    Google Scholar 

  9. Walsh C, Krigel R, Lennette E Karpatkin S. Thrombocytopenia in homosexual patients. Ann Intern Med 1985;103:542–5.

    PubMed  CAS  Google Scholar 

  10. Robinson G, Wilson SE, Williams RA. Surgery in patients with acquired immunodeficiency syndrome. Arch Surg 1987;122:1117–20.

    Google Scholar 

  11. 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 

  12. Wexner SD. Major abdominal surgery in AIDS patients. In: Goldberg SW, ed. Principles of Colon and Rectal Surgery. Minneapolis: University of Minnesota Press, 1988:40–54.

    Google Scholar 

  13. Lange M, Klein EB, Kornfield H, Cooper LZ, Grieco MH. Cytomegalovirus isolation from healthy homosexual men. JAMA 1984;252:1908–10.

    Article  PubMed  CAS  Google Scholar 

  14. Drew WL, Mintz L, Miner RC, Sands M, Ketterer B. Prevalence of cytomegalovirus infection in homosexual men. J Infect Dis 1981;143:188–92.

    PubMed  CAS  Google Scholar 

  15. Quinn TC. Gastrointestinal manifestations of AIDS. Pract Gastroenterol 1985;9:23–4.

    Google Scholar 

  16. Knapp AB, Horst DA, Eliopoulos G, et al. Widespread cytomegalovirus gastroenterocolitis in a patient with acquired immunodeficiency syndrome. Gastroenterology 1983;85:1399–402.

    PubMed  CAS  Google Scholar 

  17. Gertler SL, Pressman J, Price P, Brozinsky S, Miyai K. Gastrointestinal cytomegalovirus infection in a homosexual man with severe acquired immunodeficiency syndrome. Gastroenterology 1983;85:1403–6.

    PubMed  CAS  Google Scholar 

  18. Frank D, Raicht RF. Intestinal perforation associated with cytomegalovirus infection in patients with acquired immune deficiency syndrome. Am J Gastroenterol 1984;79:201–5.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  20. Wexner SD. Sexually transmitted diseases of the colon, rectum, and anus. In: Goldberg SM, Gordon PH, Nivatvongs S, eds. Principles and practices of surgery of the colon, rectum, and anus (in press).

  21. Leads from the MMWR. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. JAMA 1987;258:1143–54.

    Article  Google Scholar 

  22. Houin HP, Gruenberg JC, Fisher EJ, Metzger E. Multiple small bowel perforations secondary to cytomegalovirus in a patient with acquired immunodeficiency syndrome. Henry Ford Hosp Med J 1987;35:17–9.

    PubMed  CAS  Google Scholar 

  23. Balthazar EJ, Meigbow AJ, Hulnick DH. Cytomegalovirus esophagitis and gastritis in AIDS. AJR 1985;144:1201–4.

    PubMed  CAS  Google Scholar 

  24. Kram HB, Hino ST, Cohen RE, DeSantis SA, Schoemaker WC. Spontaneous colonic perforation secondary to cytomegalovirus infection in a patient with acquired immune deficiency syndrome. Crit Care Med 1984;12:469–71.

    Article  PubMed  CAS  Google Scholar 

  25. Foucar E, Mukai K, Foucar K, et al. Colon ulceration in lethal cytomegalovirus infection. Am J Clin Pathol 1981;76:788–801.

    PubMed  CAS  Google Scholar 

  26. Kevin H, Jonas RB, Chowdhury O, Robbins S. Acalculous cholecystitis and cytomegalovirus infection in the acquired immunodeficiency syndrome. Ann Intern Med 1986;104:53–4.

    Google Scholar 

  27. Schneiderman DJ, Cello JP, Laing FC. Papillary stenosis and sclerosing cholangitis in the acquired immunodeficiency syndrome. Ann Intern Med 1987;106:546–9.

    PubMed  CAS  Google Scholar 

  28. Kahn DG, Garfinkle JM, Klonoff DC, Pembrook LJ, Morrow DJ. Cryptosporidial and cytomegaloviral hepatitis and cholecystitis. Arch Pathol Lab Med 1987;111:879–81.

    PubMed  CAS  Google Scholar 

  29. Blackman E, Vimadel S, Nash G. Significance of gastrointestinal cytomegalovirus in homosexual males. Am J Gastroenterol 1984;79:935–40.

    PubMed  CAS  Google Scholar 

  30. Culpepper-Morgan JA, Kotler DP, Scholes JV, Tierney AR. Evaluation of diagnostic criteria for mucosal cytomegalic inclusion disease in the acquired immune deficiency syndrome. Am J Gastroenterol 1987;82:1264–70.

    PubMed  CAS  Google Scholar 

  31. Hinnant KL, Rotterdam HZ, Bell ET, Tapper ML. Cytomegalovirus infection of the alimentary tract: a clinicopathological correlation. Am J Gastroenterol 1986;81:944–50.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  33. Underwood JCE, Corbett CL. Persistent diarrhea and hypoalbuminemia associated with cytomegalovirus enteritis. Br Med J 1978;1:1029–30.

    Article  PubMed  CAS  Google Scholar 

  34. Campbell DS, Piercey JR, Shnitka JK, et al. Cytomegalovirus-associated gastric ulcer. Gastroenterology 1977;72:533–5.

    PubMed  CAS  Google Scholar 

  35. Nugent P, O'Connell TX. The surgeon's role in treating acquired immunodeficiency syndrome. Arch Surg 1986;121:1117–20.

    PubMed  CAS  Google Scholar 

  36. Nelson JA, Wiley CA, Reynolds-Kohler C, Reese CE, Margaretten W, Levy JA. Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. Lancet 1988;1:259–62.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, The Roosevelt Hospital, New York, New York

    Steven D. Wexner M.D., William B. Smithy M.D., Carlos Trillo M.D., B. Smith Hopkins M.D. & Thomas H. Dailey M.D.

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  1. Steven D. Wexner M.D.
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  2. William B. Smithy M.D.
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  3. Carlos Trillo M.D.
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  4. B. Smith Hopkins M.D.
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  5. Thomas H. Dailey M.D.
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Wexner, S.D., Smithy, W.B., Trillo, C. et al. Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome. Dis Colon Rectum 31, 755–761 (1988). https://doi.org/10.1007/BF02560100

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