CMV colitis presenting as acute abdomen requires early diagnosis and treatment to avoid mortality

Acute CMV-colitis is an unusual cause of emergency colectomy in a general surgical department. The aim of this article is to report our experience on CMV colitis as a cause of acute abdomen.

Five patients were referred to general surgery during a three-year period with acute abdomen due to gastrointestinal CMV disease. All patients underwent serology for CMV except case 5. In all patients a gastroscopy or colonoscopy or both, based on individual clinical symptoms, was performed. Abdominal CT scan was requested in patients 1 and 2. Antiviral therapy was instituted in all patients. One patient (case 5) underwent surgery without prior diagnosis of CMV.

There were four men and a woman with a median age of 56 years. Abdominal CT revealed perforation in one patient, later confirmed at laparotomy. Four patients had a positive CMV diagnosis either on serology or tissue biopsy or both. Three patients were treated surgically of whom two died of multiorgan failure.

CMV may behave in the intestine as a non-pathogenic bystander. However, any condition that compromises the immune status may be sufficient to trigger its virulence. Severe colitis commits clinicians to start or increase immunosuppression regimens, whereas in gastrointestinal CMV disease such an approach inevitably aggravates the clinical picture. Tissue biopsy remains the gold standard test in CMV colitis. However, a positive diagnosis by 'any means' should prompt early antiviral treatment. Surgery should be limited to acute complications of CMV colitis and to unresponsive disease.