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Surgical treatment of cytomegalovirus enterocolitis in severe human immunodeficiency virus infectionReport of eight cases

 

作者: Claes Söderlund,   Göran Bratt,   Lennart Engström,   Sven Grützmeier,   Roland Nilsson,   Margorzata Sjunnesson,   Eric Sandström,  

 

期刊: Diseases of the Colon & Rectum  (OVID Available online 1994)
卷期: Volume 37, issue 1  

页码: 63-72

 

ISSN:0012-3706

 

年代: 1994

 

出版商: OVID

 

关键词: AIDS;HIV infection;CMV enterocolitis;CMV infection;Ileocecal resection;Hemicolectomy;Foscarnet(Foscavir®);Ganciclovir(Cymevene®);Immune deficiency

 

数据来源: OVID

 

摘要:

PURPOSE:The aim of this study was to describe our experiences of surgical removal of inflamed bowel in cytomegalovirus enterocolitis.METHODS:Eight homosexual males with a mean age of 41 years (range, 29‐59 years) and a mean CD4 count of 21×106/1 (1‐60× 106/1)with advanced human immunodeficiency virus infection and severe cytomegalovirus enterocolitis were treated with ileocecal resection (4 patients) or right‐sided hemicolectomy (4 patients). Symptoms were lower abdominal pain, severe diarrhea, fever, and weight loss, unrelieved by anticytomegalovirus therapy. Radiologic examination showed that ulcerative inflammation was limited to the right colon and terminal ileum. Microscopic examination confirmed the cytomegalovirus enterocolitis. Intermittent cytomegalovirus treatment, usually with foscarnet for 10 to 14 days every 4 to 6 weeks was given postoperatively.RESULTS:Two minor postoperative complications occurred: a lesser wound infection and a moderate bleeding from the abdominal wound edges. One patient died after three weeks because of gastrointestinal bleeding from an ulcerating Kaposi's sarcoma lesion and another patient died from unrelated causes three weeks after discharge from the hospital. The remaining 6 patients experienced complete or partial palliation of the abdominal symptoms for a mean of 14 months (range, 5‐35 months) until death or the end of observation time. One patient is still alive two years after the operation. The overall mean survival was 12 months (range, 0.5‐35 months). Recurrent or persistent symptoms and/or signs of cytomegalovirus enterocolitis occurred in four patients after a mean of seven months.CONCLUSION:Resection of inflamed bowel combined with postoperative anticytomegalovirus treatment leads to excellent palliation and a relatively favorable survival in AIDS patients with cytomegalovirus enterocolitis.

 

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