SURGICAL-TREATMENT OF CYTOMEGALOVIRUS ENTEROCOLITIS IN SEVERE HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - REPORT OF 8 CASES

PURPOSE: The aim of this study was to describe our experiences of surg ical removal of inflamed bowel in cytomegalovirus enterocolitis. METHO DS: Eight homosexual males with a mean age of 41 years (range, 29-59 y ears) and a mean CD4 count of 21 x 10(6)/1 (1-60 x 10(6)/1) with advan ced human immunodeficiency virus infection and severe cytomegalovirus enterocolitis were treated with ileocecal resection (4 patients) or ri ght-sided hemicolectomy (4 patients). Symptoms were lower abdominal pa in, severe diarrhea, fever, and weight loss, unrelieved by anticytomeg alovirus therapy. Radiologic examination showed that ulcerative inflam mation 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 ev ery 4 to 6 weeks was given postoperatively. RESULTS: Two minor postope rative 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 expe rienced complete or partial palliation of the abdominal symptoms for a mean of 14 months (range, 5-35 months) until death or the end of obse rvation time. One patient is still alive two years after the operation . The overall mean survival was 12 months (range, 0.5-35 months). Recu rrent or persistent symptoms and/or signs of cytomegalovirus enterocol itis occurred in four patients after a mean of seven months. CONCLUSIO N: Resection of inflamed bowel combined with postoperative anticytomeg alovirus treatment leads to excellent palliation and a relatively favo rable survival in AIDS patients with cytomegalovirus enterocolitis.