Cytomegalovirus Colitis Associated with Ileocolic Intussusception in a Child Status Post Heart Transplant

Case Report

Austin J Surg. 2014;1(6): 1030.

Cytomegalovirus Colitis Associated with Ileocolic Intussusception in a Child Status Post Heart Transplant

Kemp CD1, Scholz S3, Subhawong AF2, Abdullah F1 and Rasmussen SK4*

1Division of Pediatric Surgery, Johns Hopkins University, USA

2Department of Pathology, Johns Hopkins University, USA

3Department of Surgery, Children’s Hospital of Pittsburgh, USA

4Division of Pediatric Surgery, University of Virginia, USA

*Corresponding author: Rasmussen SK, Division of Pediatric Surgery, University of Virginia, Charlottesville, VA, USA

Received: May 12, 2014; Accepted: August 30, 2014; Published: September 05, 2014


A pediatric heart recipient presented with intermittent abdominal pain. Workup revealed intussusception with associated pneumatosis. A right hemicolectomy was performed. Pathologic examination revealed cytomegalovirus (CMV) colitis. This is the first case of CMV-colitis associated with intussusception in a pediatric transplant patient. We present the findings and review of the literature.

Keywords: Cytomegalovirus infection; Colitis; Pediatric heart transplant; Pediatric immunosuppression; Pneumatosis intestinalis


CMV: Cytomegalovirus; CT: Computed Tomography; PCR: Polymerase Chain Reaction

Case Presentation

A 9 year old boy with a history of cardiac transplant for hypoplastic left heart syndrome (HLHS) presented to the Johns Hopkins Hospital with acute abdominal pain. His post-cardiac transplant course was significant for two episodes of biopsy-proven rejection in the intervening 6 months prior to presenting to the pediatric surgery service. On the day of presentation, his chief complaint was abdominal pain and diarrhea. His outpatient immunosuppression regimen consisted of tacrolimus, mycophenolate mofetil, and prednisolone. A plain film of the abdomen was obtained (Figure 1). This demonstrated an ileocolic intussusception with extensive pneumatosis of both the intussusceptum and the intussuscipiens. The patient’s clinical status (tachycardic with diffuse abdominal pain) and the findings of pneumatosis suggested significant bowel compromise. It was determined that an attempt at air contrast reduction in an immunosuppressed patient with such extensive pneumatosis was contraindicated and operative intervention was planned immediately A computed tomography (CT) scan of the abdomen and pelvis was performed to evaluate for pneumoperitoneum (Figure 2). This was negative and the child was taken directly to the operating room.