Abstract :
A 83-year-old woman was admitted with dull-aching peri-umbilical abdominal pain, nausea and
vomiting for 2 weeks after an initial episode of gastroenteritis. Physical examination showed mild abdominal
distension, normal bowel sounds with mild bilateral lower quadrant tenderness and rebound.
The plain film of the abdomen revealed mild generalized small bowel dilatation and mucosal swelling at
the terminal ileum and CT scan confirmed that terminal ileal bowel wall swelling and stenosis. CMV was
confirmed from biopsies taken at colonoscopy. But CMV viral load could not be detected from the blood
sample. Investigations revealed hyponatremia which on further testing was thought to be secondary to
SIADH.
Intravenous ganciclovir was prescribed but she progressed to clinical gut obstruction. Exploratory
laparotomy and terminal iliectomy was performed which showed a terminal ileal stricture. After surgery
and intravenous ganciclovir for 3 weeks, she was symptom-free with resolution of the hyponatremia. |
file/Thai-Journal-of-gastroenterology-vol-13-no-2-4702410.pdf