Acute Pancreatitis: Bench to the Bedside

Objective: To describe the pathogenesis of gastrointestinal cytomegalovirus (CMV) disease, the types and locations of gastrointestinal lesions, the clinical settings in which they occur, and the sp...

Gastrointestinal cytomegalovirus disease.

Cytomegalovirus infection in patients with inflammatory bowel disease

PURPOSE: Cytomegaloviral enterocolitis is an uncommon disorder that can complicate inflammatory bowel disease. It is more common in patients with acquired immunodeficiency syndrome and can occur in patients on immunosuppressive therapy for autoimmune or inflammatory diseases and in allograft recipients. Mortality rates of up to 71 percent have been reported for cytomegaloviral enterocolitis. The aims of this study were 1) to identify the presentation, underlying medical conditions, treatment, and outcome of patients with cytomegaloviral enterocolitis and 2) to determine the prevalence of this infection in patients undergoing intestinal resection for inflammatory bowel disease. METHODS : A retrospective chart review of patients with pathologic evidence of cytomegaloviral enterocolitis from 1985 through 1996 was performed. To determine the prevalence of this condition, the hospital discharge database was searched for the diagnoses of ulcerative colitis and Crohn's disease in patients who underwent bowel resection. RESULTS : 93 patients (mean age, 44 years; 66 percent males) had cytomegaloviral infection in the small intestine (n = 6), large intestine (n = 86), or appendix (n = 1). Patients with acquired immunodeficiency syndrome (n = 42), with ulcerative colitis (n = 11), with Crohn's disease (n = 11), receiving organ transplant (n = 12), receiving bone marrow transplant (n = 8), and in other immunosuppressed states (n = 11) comprised this study. Seventeen patients (18 percent) underwent intestinal resection, and the remaining 76 patients were treated medically. Abdominal pain (77 vs. 37 percent; P < 0.01) and gastrointestinal bleeding (65 vs. 34 percent; P < 0.05) were more common presenting symptoms in patients who required resection than patients in the medically managed group. Mortality was 17.6 percent in the surgically managed group and 14.5 percent in the patients who were managed medically. The median duration of ulcerative colitis in patients with coexisting cytomegaloviral infection was 12 months. The prevalence of cytomegaloviral enterocolitis was 4.6 percent in patients with ulcerative colitis and 0.8 percent in patients with Crohn's disease. CONCLUSIONS: These data suggest that cytomegaloviral infection more frequently complicates ulcerative colitis than Crohn's disease. Furthermore, a short and fulminant course of ulcerative colitis may indicate coexisting cytomegaloviral infection. The overall low mortality in this retrospective study suggests that aggressive medical and surgical treatment improves survival in patients with cytomegaloviral enterocolitis.

Cytomegaloviral enterocolitis: clinical associations and outcome.

https://www.gastrojournal.org/article/0016-5085(88)90630-0/pdf

Self-limited cytomegalovirus colitis in immunocompetent individuals

https://www.gastrojournal.org/article/S0016-5085(76)80115-1/pdf

Tumor-induced acute pancreatitis.

• We report a 12th case in which infection of the colon with cytomegalovirus was demonstrated in association with ulcerative colitis. Rectal biopsy has proven to be reliable in identifying cells with cytomegaloviral inclusion bodies if careful histologic evaluation is performed. Thus far, prognosis has been serious when cytomegalovirus of the colon has been documented in ulcerative colitis. Nine of 12 patients have required a colectomy, and only seven of 12 have survived. (Arch Surg114:857-859, 1979)

Cytomegalovirus Infection of the Colon Associated With Ulcerative Colitis

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Tumor-induced acute pancreatitis.

Cytomegalovirus Infection of the Colon Associated With Ulcerative Colitis