title: Successful treatment of multiple small-bowel perforations caused by cytomegalovirus in a patient with malignant lymphoma: report of a case.
abstract: We report the successful management of multiple small-bowel perforations caused by cytomegalovirus (CMV) infection in a 60-year-old man, 1 day after CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) therapy induction for malignant lymphoma. Emergency laparotomy was performed for perforative peritonitis, but we did not resect the lesions at this time. Instead, we exteriorized the small bowel and then irrigated the peritoneal cavity and intestinal tract. His white blood cell count was low, at 200 cells/microl, so this therapy was continued until it recovered. The intestine was highly edematous, but it improved after irrigation with peritoneal dialysis solution. In the second-stage procedure, we resected the small bowel with the perforations, and constructed a jejunostomy and colostomy, then closed the abdominal cavity. Although the patient needed central venous hyperalimentation, he had a favorable postoperative course and started treatment again for the malignant lymphoma.
authors.affiliation: Departments of General Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Yokohama 236-0004, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Nishii
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Kohei
authors.initials: K
authors.lastname: Ando
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuzu
authors.forename: Hiroo
authors.initials: H
authors.lastname: Wada
authors.forename: Akihiko
authors.initials: A
authors.lastname: Chiba
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Arai
authors.forename: Akio
authors.initials: A
authors.lastname: Ashida
authors.forename: Kimiatsu
authors.initials: K
authors.lastname: Hasuo
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Inayama
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takanashi
mesh_terms: D000914:Antibodies, Viral / Q000032:analysis*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000821:virology; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000628:therapy*; D007421:Intestine, Small; D008223:Lymphoma / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage / Q000379:methods*; D012422:Rupture, Spontaneous
chemical_list: D000914:Antibodies, Viral