2023 Volume 56 Issue 2 Pages 87-93
The patient was a 66-year-old man on maintenance dialysis for chronic renal failure due to Fabry’s disease. Due to worsening of empyema after partial lung resection performed for right lung cancer, small intestine perforation and panperitonitis developed during systemic management in the intensive care unit. The patient was referred to our department and emergency surgery was performed for small intestine perforation of unknown cause. Intraoperative findings showed perforation of the small intestine about 200 cm from the ligament of Treitz, perforation from the mesenteric side into the abdominal cavity, and significant intraperitoneal contamination. A 20-cm length of the small intestine was resected and the remaining intestine was washed and drained. Ileostomy was then performed. The resected specimen showed multiple ulcers on the mucosal surface, one of which was perforated. Immunohistopathological examination revealed cells that were positive for cytomegalovirus (CMV) in the ulcer area, leading to diagnosis of small intestinal perforation due to CMV infection. Gastrointestinal perforation due to CMV infection is rare, but should be considered in immunocompromised patients. Early diagnosis and treatment are particularly important.
