1/20. cytomegalovirus colitis in the immunocompetent host: an overview.This paper describes 2 immunocompetent patients with cytomegalovirus colitis and reviews all previously reported cases (n = 13). Affected patients were generally older (69.13 /-15.62 y-old) with probable reactivation (n = 8) or younger (43.86 /-19.73 y-old) with probable primary infection (n = 7). The onset of illness was found to be hospital-associated in 4 (50.0%) reactivation cases and 1 (14.3%) primary case. Presenting manifestations included diarrhoea (86.7%), fever (80.0%), gastrointestinal bleeding (66.7%) and abdominal pain (60.0%). endoscopy showed erosive colitis with multiple (n = 11; 73.3%) or single ulcers (n = 2, 13.3%); biopsy was diagnostic in 12/13 (92.3%) patients. Complications included massive haemorrhage (13.3%), toxic megacolon (13.3%), perforation (13.3%) and protracted inflammatory bowel disease (20.0%; exclusively in primary-infection). The mortality rate was 26.7%. Antiviral-agents were given in 8 (53.3%) cases; assessment of treatment-efficacy was not possible. In conclusion, cytomegalovirus colitis in the immunocompetent-host is a rare but potentially severe erosive disease with significant morbidity. It may occur during primary infection or reactivation; the diagnosis requires careful histopathological examination and the benefit of antiviral-therapy is unknown.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/20. cytomegalovirus colitis in individuals without apparent cause of immunodeficiency.cytomegalovirus infection is usually reported in immunocompromised patients. In this study, apparently immunocompetent patients with cytomegaloviral colitis were reviewed. Records with a diagnosis of cytomegaloviral colitis from January 1989 to June 1996 were retrieved for analysis. Ten patients were included (median age 70 yr). The major presenting symptoms were diarrhea and hematochezia. Ulceration was the main macroscopic finding. Rectal bleeding was mostly self-limiting. Three patients developed local complications (rectovaginal fistula in two; rectal stricture in one). In the two patients with rectovaginal fistula, lymphocytes subsets and proliferative response were entirely normal. In the other patient, low B lymphocyte count and low response to mitogen were demonstrated. However, the immunoglobulins were not suppressed and rectal biopsies revealed noncaseating granulomas, suggesting activated cell-mediated immunity. In conclusion, a high index of suspicion is crucial for early diagnosis of cytomegaloviral colitis in patients with bloody diarrhea, even though obvious evidence of immunodeficiency is lacking.- - - - - - - - - - ranking = 223.23231138273keywords = hematochezia (Clic here for more details about this article) |
3/20. Allergic colitis presenting in the first day of life: report of three cases.Allergic colitis can occur within hours of birth and should be considered in the differential diagnosis of any newborn in whom hematochezia develops. This diagnosis should be considered after excluding infectious and anatomic disorders common to this age group. The diagnosis is supported by the healthy appearance of affected infants and specific proctosigmoidoscopic and histopathologic findings. Infants with allergic colitis usually respond to withdrawal of the offending antigen, by the use of hydrolyzed cow's milk protein formula or more elemental formulas, or if the infant has been breast fed, by the strict removal of the offending antigen from the breast-feeding mother's diet.- - - - - - - - - - ranking = 223.23231138273keywords = hematochezia (Clic here for more details about this article) |
4/20. Acute upper gastrointestinal haemorrhage and colitis: an unusual presentation of Wegener's granulomatosis.Wegener's granulomatosis is a rare necrotizing vasculitis usually affecting the respiratory tract and kidneys. The aetiology is unknown and it usually occurs in patients over the age of 40. Involvement of the gastrointestinal tract in Wegener's granulomatosis is relatively rare and usually occurs long after the onset of initial symptoms. Acute colitis as a presenting feature of Wegener's granulomatosis is very rare with only a few reports in the literature. We describe a young woman who presented initially to hospital with gastrointestinal features and then developed a severe colitis and severe gastrointestinal haemorrhage. This preceded the development of respiratory tract features with severe pulmonary haemorrhage, haemoptysis and the development of rapidly progressive renal failure and nasal septal perforation. Following treatment with intravenous steroids and cyclophosphamide, gastrointestinal symptoms and signs improved dramatically, as did her pulmonary disease. She still remains dialysis dependent, due to end-stage renal disease secondary to glomerulonephritis.- - - - - - - - - - ranking = 6keywords = haemorrhage (Clic here for more details about this article) |
5/20. cytomegalovirus colitis presenting as hematochezia and requiring resection.cytomegalovirus infection is one of the most prevalent viral infections affecting recipients of cardiac allografts. Of the various severe systemic manifestations, those in the gastrointestinal tract have a unique way of presenting, specifically in the colon where a process related to cytomegalovirus infection that involves all layers, with dilatation as a prominent clinical feature, has been suggested. We report herein a case of patient with a heart allograft who had severe episodes of rejection that responded to boosting doses of steroids. Because of persistent fever, diarrhea, hematochezia, and computed tomographic findings of the abdomen that showed a highly abnormal appearance of the ascending and transverse segments of the colon, this patient subsequently underwent celiotomy. The involved segment of the colon was found to have severe inflammation with mucosal necrosis; a subtotal colectomy was done. The abundant cytomegalovirus inclusions found in the vascular endothelium of the removed damaged segment of the colon suggest that cytomegalovirus may have been a causal factor in this form of colitis. The patient recovered uneventfully.- - - - - - - - - - ranking = 1116.1615569137keywords = hematochezia (Clic here for more details about this article) |
6/20. octreotide treatment of massive hemorrhage due to cytomegalovirus colitis.cytomegalovirus (CMV)-associated colitis can result in abdominal pain, diarrhea, significant blood loss and perforation. The standard therapy for CMV colitis includes supportive measures and antiviral medications. Severe hemorrhage due to CMV colitis often necessitates surgical resection. We present a case of a patient who was undergoing chemotherapy for acute B-cell lymphoblastic leukemia and developed significant abdominal pain and diarrhea followed by massive hematochezia. colonoscopy showed numerous actively bleeding deep ulcers in the cecum. A provisional diagnosis of CMV colitis was made and she was started on ganciclovir. Histological assessment confirmed the diagnosis of CMV colitis. She continued to bleed profusely per rectum over the following five days, passing up to 1 L to 1.5 L of blood per day. She required 10 units of packed red blood cells over this time period. The patient refused surgical intervention and after discussion of possible options, octreotide was instituted. Her blood loss stopped almost immediately and she required no further transfusions. She tolerated the medication well and was discharged home at a later date in stable condition. This is the first reported case of the use of octreotide in the treatment of massive hematochezia from CMV colitis.- - - - - - - - - - ranking = 446.46462276547keywords = hematochezia (Clic here for more details about this article) |
7/20. methamphetamine-induced ischemic colitis.A 50-year-old woman with acute onset of right lower quadrant pain and hematochezia proved to have segmental ischemic colitis associated with methamphetamine abuse. The diagnosis was established by colonoscopy with biopsy, and abdominal angiography revealed no thrombosis, vasculitis, or vasospasm. The condition resolved within 10 days. Since methamphetamine abuse is increasing, physicians should be aware of its potential to produce intestinal ischemia.- - - - - - - - - - ranking = 223.23231138273keywords = hematochezia (Clic here for more details about this article) |
8/20. Toxic megacolon in cytomegalovirus colitis.We report a case of toxic megacolon manifesting in cytomegalovirus (CMV) colitis in a 55-yr-old man with steroid-dependent chronic obstructive pulmonary disease. He presented to the hospital with increasing dyspnea and low-grade fever. His hospital course was characterized by the poor response of his symptoms to treatment, and by the subsequent development of intermittent hematochezia and, eventually, acute abdomen. The surgical specimen showed dilatation of the cecum and ascending colon with a solitary mucosal ulcer in the latter. The major histologic changes were limited to the area of ulceration. In addition to classical CMV inclusions. vasculitis manifested in two forms, namely, leukocytoclastic type and fibrinoid necrosis. The patient died shortly thereafter, due to multi-organ system failure. To our knowledge, this represents the first reported case of toxic megacolon due to CMV infection without underlying inflammatory bowel disease. The pathogenesis of toxic colonic dilatation remains unknown.- - - - - - - - - - ranking = 223.23231138273keywords = hematochezia (Clic here for more details about this article) |
9/20. cytomegalovirus colitis. Report of the clinical, endoscopic, and pathologic findings in two patients with the acquired immune deficiency syndrome.We report 2 homosexual patients with the acquired immune deficiency syndrome and histopathologic evidence for cytomegalovirus colitis. In each case, the initial endoscopic impression was Kaposi's sarcoma but the appropriate diagnosis was made by histologic demonstration of a cytomegalovirus vasculitis. Clinical manifestations may include diarrhea, abdominal pain, and hematochezia. Fulminant progression to gangrenous bowel was documented in 1 patient and was associated with histologic evidence of severe cytomegalovirus vasculitis. The pertinent clinical, endoscopic, and pathologic findings are reviewed.- - - - - - - - - - ranking = 223.23231138273keywords = hematochezia (Clic here for more details about this article) |
10/20. Typhoid colitis with massive lower gastrointestinal bleeding. An unexpected behavior of salmonella typhi.Three cases of salmonella colitis with massive lower gastrointestinal hemorrhage are presented. The patients had fever, diarrhea, and abundant hematochezia; blood and bone marrow cultures were positive for salmonella typhi. Because of bleeding, all patients underwent hemicolectomy; previous mesenteric arteriograms showed the colonic hemorrhagic sites. The pathologic and radiologic findings are described.- - - - - - - - - - ranking = 223.23231138273keywords = hematochezia (Clic here for more details about this article) |
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