Fecal diversion for the treatment of fulminant cytomegalovirus colitis: report of a case.

Cytomegalovirus (CMV) colitis in the immunosuppressed patient is common and is usually self-limited by treatment consisting of intravenous anti-viral medications. However, in the immunocompetent patient, CMV colitis is extremely rare and is associated with a high mortality rate that approaches 32 % (Galiatsatos et al. in Dig Dis Sci 50:609-616, 2005). We herein present the case of a 45-year-old immunocompetent male who developed fulminant CMV colitis. He was initially started on anti-viral agents but the disease continued to progress. After a surgical consultation was obtained, he underwent diverting loop ileostomy in an attempt to avoid a total abdominal colectomy. He responded well and had successful resolution of his disease. Approximately nine months later, he underwent successful ileostomy takedown. Diversion may be an alternative to total abdominal colectomy for CMV colitis or other causes of fulminant colitis. Given the rare nature of fulminant CMV colitis, further randomized studies will be difficult; however, this does appear to be a treatment option as an alternative to total abdominal colectomy.