title: Surgical treatment of cytomegalovirus enterocolitis in severe human immunodeficiency virus infection. Report of eight cases.
abstract: OBJECTIVE
  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 x 10(6)/l (1-60 x 10(6)/l) 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.
  
  
  CONCLUSIONS
  Resection of inflamed bowel combined with postoperative anticytomegalovirus treatment leads to excellent palliation and a relatively favorable survival in AIDS patients with cytomegalovirus enterocolitis.
authors.affiliation: Department of Surgery, Södersjukhuset, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Söderlund
authors.forename: G A
authors.initials: GA
authors.lastname: Bratt
authors.forename: L
authors.initials: L
authors.lastname: Engström
authors.forename: S
authors.initials: S
authors.lastname: Grützmeier
authors.forename: R
authors.initials: R
authors.lastname: Nilsson
authors.forename: M
authors.initials: M
authors.lastname: Sjunnesson
authors.forename: E
authors.initials: E
authors.lastname: Sandström
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002432:Cecum / Q000601:surgery; D003082:Colectomy; D003131:Combined Modality Therapy; D003586:Cytomegalovirus Infections; D004760:Enterocolitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents