내시경 풍선확장술로 호전된 거대세포바이러스 대장염 관련 직장협착 1예 = A Case of a Cytomegalovirus Colitis Related Rectal Stricture Treated by Endoscopic Balloon Dilation

다국어 초록 (Multilingual Abstract)

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.

국문 초록 (Abstract)

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 엉덩동맥 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.

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