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Intestinal perforation due to cytomegalovirus infection in patients with AIDS
1Department of Surgery, Los Angeles County King/Drew Medical Center, California 90059.
Abstract:
Intestinal perforation due to cytomegalovirus (CMV) infection in patients with AIDS is the most common life-threatening condition requiring emergency celiotomy in these patients. The authors describe a patient with AIDS with intestinal perforation due to CMV infection, and review 14 additional cases reported in the English-language surgical literature. The diagnostic triad of pneumoperitoneum on x-ray, evidence or history of CMV infection, and AIDS occurred in 70 percent of patients. The most common site of intestinal perforation was the colon (53 percent), followed in frequency by the distal ileum (40 percent) and appendix (7 percent); perforation usually occurred between the distal ileum and splenic flexure of the colon. Colonoscopy, rather than sigmoidoscopy, is recommended as a screening examination in patients with AIDS suspected of having colonic ulceration due to CMV infection. Multiple biopsies of ulcerated tissue should be obtained. Gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and CMV infection. Despite aggressive therapy, the operative mortality rate in patients with AIDS with intestinal perforation due to CMV infection was 54 percent and the overall mortality rate was 87 percent. Postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by Pneumocystis carinii infection. An increased awareness of this syndrome by physicians frequently called on to manage patients with AIDS is recommended.
Insights
Cytomegalovirus (CMV) infection causes intestinal perforation in patients with Acquired Immunodeficiency Syndrome (AIDS), often requiring emergency surgery. High mortality rates underscore the need for increased physician awareness and prompt diagnosis of this severe complication.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Cytomegalovirus (CMV) infection is a significant threat in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Intestinal perforation secondary to CMV infection represents a life-threatening emergency in this population, frequently necessitating urgent surgical intervention.
Observation:
- A diagnostic triad of pneumoperitoneum on radiography, confirmed CMV infection, and AIDS was observed in 70% of cases.
- The colon (53%) and distal ileum (40%) were the most common sites of intestinal perforation.
- Perforations typically occurred in the segment between the distal ileum and the splenic flexure of the colon.
Findings:
- Histopathological analysis revealed characteristic ulceration and CMV infection in affected intestinal tissues.
- Colonoscopy with biopsies is recommended for suspected CMV-induced colonic ulceration in AIDS patients.
- Despite aggressive management, the operative mortality rate was 54%, with an overall mortality of 87%.
Implications:
- This syndrome demands heightened clinical suspicion among physicians managing patients with AIDS.
- Prompt recognition and diagnosis are crucial for potentially improving outcomes in CMV-related intestinal perforation.
- Postoperative complications, including sepsis and Pneumocystis pneumonia, are frequent and contribute to high mortality.