ArticleGeneral thoracic and cardiovascular surgery cases2023
Large bowel perforation due to cytomegalovirus colitis in a post-cardiac surgical patient on chronic hemodialysis.
Article in General thoracic and cardiovascular surgery cases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCytomegalovirus (CMV) colitis with colonic perforation is an exceedingly rare but life-threatening condition. The most comorbid diagnosis in patients with perforated CMV colitis is human immunodeficiency virus in the setting of advanced immunosuppression associated with CD4 < 50 cells/μL. CASE PRESENTATION: A 75-year-old female with a ≥ 30-year history of hemodialysis presented with progressive dyspnea on exertion. Transthoracic echocardiography showed moderate mitral stenosis and severe aortic stenosis. Although she was a high-risk candidate with a risk for mortality of 17.17% and morbidity and mortality both of 35.63% in The Society of Thoracic Surgeons risk calculator, we performed mitral and aortic valve replacement with both biological valves. Postoperative course was complicated with a high dose of inotropic support, cardiac tamponade requiring open drainage, and the need for a tracheostomy. Abdominal distension was observed, and enhanced computed tomography demonstrated free air and a suspected perforated sigmoid colon. Emergency laparotomy revealed a 20-cm longitudinal perforation in the sigmoid colon. A left hemicolectomy with stoma was performed. Immunostaining of a sample of her colon showed cytomegalovirus-positive cells.
conclusionsCardiac surgeons should consider cytomegalovirus colitis as a differential diagnosis during the course of cardiac surgery even in immunocompetent patients.
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