Clinical Endoscopy

  • 제41권4호
  • /
  • Pages.240-244
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  • 2010
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

내시경 풍선확장술로 호전된 거대세포바이러스 대장염 관련 직장협착 1예

A Case of a Cytomegalovirus Colitis Related Rectal Stricture Treated by Endoscopic Balloon Dilation

  • 박권오 (한림대학교 의과대학 내과학교실) ;
  • 김경호 (한림대학교 의과대학 내과학교실) ;
  • 박종원 (한림대학교 의과대학 내과학교실) ;
  • 이상호 (한림대학교 의과대학 내과학교실) ;
  • 조현정 (한림대학교 의과대학 내과학교실) ;
  • 천승연 (한림대학교 의과대학 내과학교실) ;
  • 박혜원 (한림대학교 의과대학 내과학교실) ;
  • 김학량 (한림대학교 의과대학 내과학교실)
  • Park, Kwon-Oh (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kim, Kyung-Ho (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Park, Jong-Won (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Sang-Ho (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Jo, Hyun-Jung (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Chun, Seung-Yun (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Park, Hye-Won (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kim, Hak-Yang (Department of Internal Medicine, Hallym University College of Medicine)
  • 투고 : 2010.05.25
  • 심사 : 2010.09.06
  • 발행 : 2010.10.30
⟨ 이전 논문 다음 논문 ⟩

초록

거대세포바이러스 대장염은 면역기능이 저하된 환자에서 흔히 발생하는 기회 감염이다. 그러나 드물게 면역기능이 정상인 사람에서도 발병한다. 복통, 설사 및 출혈 등의 임상증상을 보이며, 합병증은 대량 출혈, 독성 거대 결장, 장천공 등이 있으나 대장의 협착은 드물다. 69세 여자가 교통사고로 우측 엉덩 동맥 파열과 엉덩뼈 골절로 정형외과에 입원하였다. 환자는 응급 혈관조영술 및 코일색전술을 시행받고 호전되었으나, 사고 2주째부터 혈변과 반복적인 복통을 호소하였다. 대장내시경검사에서 직장 주변에 커다란 깊은 궤양을 확인하였고 조직검사와 면역조직염색으로 거대세포바이러스 대장염을 진단하였다. 항바이러스제 치료 후 환자의 증상은 호전되었으나, 3개월 뒤 시행한 대장내시경검사에서 직장 협착이 발견되었다. 환자는 복통과 변비 증상을 호소하여 내시경 풍선확장술을 3회 시행하였고, 이후 증상은 호전되었다.

Cytomegalovirus (CMV) colitis is a common opportunistic infection in immunocompromised patients. Affected individuals present with abdominal pain, diarrhea, or hematochezia. Complications of CMV colitis can include massive bleeding, toxic megacolon, bowel perforation and, rarely, colon stricture. A 69-year-old woman who had no specific past history was admitted to the orthopedic department for pelvic bone fracture with right iliac artery rupture caused by a traffic accident. She was successfully managed with emergency transarterial coil embolization. After 2 weeks, she developed hematochezia and recurrent abdominal pain. Colonoscopy showed a huge, deep ulcer in the rectosigmoid colon. Biopsy and immunohistochemical staining revealed giant cells with intracellular inclusion bodies that were positive for CMV antigen. She received antiviral treatment after which her symptoms improved. On follow-up colonoscopy 3 months later, we found a tight luminal narrowing in the rectum. We did a repeat endoscopic balloon dilation in this patient and she experienced improvement.

키워드

참고문헌

  1. Lee ES, Jang MK, Park SY, et al. A case of iatrogenic tension pneumoperitoneum following colonoscopy in a patient with cytomegalovirus colitis. Korean J Gastroenterol 2006;47:312-315.
  2. Goodgame RW. Gastrointestinal cytomegalovirus disease. Ann Intern Med 1993;119:924-935. https://doi.org/10.7326/0003-4819-119-9-199311010-00010
  3. Patra S, Samal SC, Chacko A, Mathan VI, Mathan MM. Cytomegalovirus infection of the human gastrointestinal tract. J Gastroenterol Hepatol 1999;14:973-976. https://doi.org/10.1046/j.1440-1746.1999.01986.x
  4. Mariorana A, Baccarini P, Foroni M, Bellini N, Giusti F. Human cytomegalovirus infection of the gastrointestinal tract in apparently immunocompetent patients. Hum Pathol 2003;34:1331-1336. https://doi.org/10.1016/j.humpath.2003.08.005
  5. Cheung AN, Ng IO. Cytomegalovirus infection of the gastrointestinal tract in non-AIDS patients. Am J Gastroenterol 1993;88:1882-1886.
  6. Camprodon RA, Jacob S, Malkawi A, Al-Ghnaniem R. CMV colitis presenting as acute abdomen requires early diagnosis and treatment to avoid mortality. Acta Chir Belg 2007;107:378-381.
  7. Lee SY. Cytomegalovirus colitis in an immunocompetent adult. Korean J Gastroenterol 2007;50:75-77.
  8. Reyes C, Pereira S, Warden MJ, Sills J. Cytomegalovirus enteritis in a premature infant. J Pediatr Surg 1997;32:1545-1547. https://doi.org/10.1016/S0022-3468(97)90448-6
  9. Mohammed AA, Benmousa A, Almeghaiseeb I, Alkarawi M. Gastric outlet obstruction. Hepatogastroenterology 2007;54:2415-2420.
  10. Kume K, Yoshikawa I. Rectal stenosis caused by cytomegalovirus colitis. Endoscopy 2009;41(suppl 2):E197.
  11. Ng FH, Chau TN, Cheung TC, et al. Cytomegalovirus colitis in individuals without apparent cause of immunodeficiency. Dig Dis Sci 1999;44:945-952. https://doi.org/10.1023/A:1026604529393
  12. Diaz-Gonzalez VM, Altemose GT, Ogrek C, et al. Cytomegalovirus infection presenting as an apple-core lesion of the colon. J Heart Lung transplant 1997;16:1171-1175.
  13. Goodman ZD, Boitnott JK, Yardley JH. Perforation of the colon associated cytomegalovirus infection. Dig Dis Sci 1979;24:376-380. https://doi.org/10.1007/BF01297124
  14. Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci 2005;50:609-616. https://doi.org/10.1007/s10620-005-2544-6
  15. Solt J, Hertelendy A, Szilagy K. Long-term results of balloon catheter dilatation of lower gastrointestinal tract stenoses. Dis Colon Rectum 2004;47:1499-1505. https://doi.org/10.1007/s10350-004-0619-7
  16. Lee JY, Lee SH, Kim SP, et al. A case of benign colonic stricture treated by therapeutic balloon dilatation in ulcerative colitis. Korean J Gastrointest Endosc 2008;37:380-383.