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Open Access Highly Accessed Case report

Small-bowel necrosis complicating a cytomegalovirus-induced superior mesenteric vein thrombosis in an immunocompetent patient: a case report

John Kalaitzis1*, Paris Basioukas1, Eftalia Karzi2, Charalampos Markakis1, Emmanouil Liarmakopoulos1, Andreas Hadjimarkou1 and Spyros Rizos1

Author Affiliations

1 First Surgical Department, Tzaneio General Hospital, Piraeus, Greece

2 Radiology Department, Tzaneio General Hospital, Piraeus, Greece

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Journal of Medical Case Reports 2012, 6:118  doi:10.1186/1752-1947-6-118

Published: 24 April 2012

Abstract

Introduction

Superior mesenteric venous thrombosis as a result of acute cytomegalovirus infection is rare, with only a few cases reported in the literature.

Case presentation

We present the case of a 40-year-old Caucasian man who was admitted to our hospital with a 5-day history of fever. His serological test and pp65 antigen detection of cytomegalovirus were positive, suggesting acute infection. On the sixth day after his admission, the patient complained of acute, progressive abdominal pain. Abdominal computed tomography revealed acute superior mesenteric venous thrombosis. An emergency laparotomy showed diffuse edema and ischemic lesions of the small bowel and its associated mesentery with a 50-cm-long segmental infarction of the proximal jejunum. An extensive enterectomy of about 100 cm of jejunum that included the necrotic segment was performed, followed by an end-to-end anastomosis. Anti-coagulation therapy was administered pre-operatively in the form of small-fractionated heparin and continued postoperatively. The patient had an uneventful recovery and was discharged on the 11th postoperative day.

Conclusion

Acute cytomegalovirus infection can contribute to the occurrence of mesenteric venous thrombosis in immunocompetent patients. It is important for physicians and internists to be aware of the possible thrombotic complications of cytomegalovirus infection. A high level of clinical suspicion is essential to successfully treat a potentially lethal condition such as superior mesenteric venous thrombosis.

Keywords:
CMV; superior mesenteric vein; thrombosis