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Published on: December 8, 2014
Emergency gastrointestinal tract operation associated with cytomegalovirus infection
Seijong Kim1, Kyoung Won Yoon2, Eunmi Gil3,4
1Division of Colorectal Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Purpose:
Cytomegalovirus (CMV) infection is common in immunocompromised patients. Enterocolitis caused by CMV infection can lead to perforation and bleeding of the gastrointestinal (GI) tract, which requires emergency operation. We investigated the demographics and outcomes of patients who underwent emergency operation for CMV infection of the GI tract.
Methods:
This retrospective study was conducted between January 2010 and December 2020. Patients who underwent emergency GI operation and were diagnosed with CMV infection through a pathologic examination of the surgical specimen were included. The diagnosis was confirmed using immunohistochemical staining and evaluated by experienced pathologists.
Results:
A total of 27 patients who underwent operation for CMV infection were included, 18 of whom were male with a median age of 63 years. Twenty-two patients were in an immunocompromised state. Colon (37.0%) and small bowel (37.0%) were the most infected organs. CMV antigenemia testing was performed in 19 patients; 13 of whom showed positive results. The time to diagnose CMV infection from operation and time to start ganciclovir treatment were median of 9 days. The reoperation rate was 22.2% and perforation was the most common cause of reoperation. In-hospital mortality rate was 25.9%.
Conclusion:
CMV infection in the GI tract causes severe effects, such as hemorrhage or perforation, in immunocompromised patients. When these outcomes are observed in immunocompromised patients, suspicion of CMV infection and further evaluation for CMV detection in tissue specimens is required for proper treatment.
Insights
Cytomegalovirus (CMV) infection in immunocompromised patients can cause severe gastrointestinal issues, necessitating emergency surgery. Outcomes for these patients show a high mortality rate, emphasizing the need for prompt diagnosis and treatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Cytomegalovirus (CMV) infection is a significant concern in immunocompromised individuals.
- CMV infection of the gastrointestinal (GI) tract can lead to life-threatening complications like perforation and bleeding.
Purpose of the Study:
- To investigate the demographics and outcomes of patients requiring emergency surgery for CMV infection of the GI tract.
Main Methods:
- Retrospective study of 27 patients undergoing emergency GI operations for CMV infection between 2010-2020.
- Diagnosis confirmed via pathological examination of surgical specimens, including immunohistochemical staining.
- Evaluation of patient demographics, clinical presentation, treatment, and outcomes.
Main Results:
- The study included 27 patients (median age 63, 22 immunocompromised).
- Colon and small bowel were the most frequently affected sites (37.0% each).
- High in-hospital mortality (25.9%) and reoperation rate (22.2%) were observed, with perforation being a common reason for reoperation.
Conclusions:
- CMV infection in the GI tract poses severe risks, including hemorrhage and perforation, particularly in immunocompromised patients.
- Early suspicion and diagnostic evaluation of CMV in tissue specimens are crucial for effective management.
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