Fecal colitis obliterans and cytomegalovirus enteritis after pancreaticoduodenectomy for resectable pancreatic cancer

TL;DR

A patient with pancreatic cancer developed severe bowel complications after surgery, highlighting the risks of preoperative treatment and the need for careful perioperative management.

Contribution

This case highlights the rare but serious complications of colitis obliterans and cytomegalovirus enteritis in immunocompromised pancreatic cancer patients.

Findings

Preoperative chemotherapy and pancytopenia likely contributed to colitis obliterans during surgery.

Cytomegalovirus enteritis occurred due to immunocompromised status after gastrointestinal hemorrhage.

Perioperative bowel control and colonoscopy are critical in managing such high-risk patients.

Abstract

A 74-year-old male patient with a resectable pancreatic cancer underwent radical surgery after receiving neoadjuvant chemotherapy. The patient went into shock after surgery owing to sepsis caused by fecal impaction. The sepsis healed rapidly after the patient was encouraged to defecate through stool evacuation. He subsequently presented with gastrointestinal bleeding from an aneurysm, requiring interventional radiology hemostasis and blood transfusion. Bleeding continued after arterial embolization. On the 35th day after surgery, cytomegalovirus enteritis was detected during a lower gastrointestinal endoscopy, for which the patient was treated with ganciclovir. Pancytopenia and constipation resulting from preoperative treatment likely contributed to the intraoperative progression of colitis obliterans. Colonic damage and gastrointestinal hemorrhage may have led to cytomegalovirus enteritis due to immunocompromised status. The combination of preoperative chemotherapy, massive bleeding, and colitis obliterans is important in an immunocompromised state and can occur in the perioperative period of pancreatic cancer. This case demonstrates the importance of perioperative bowel control during highly invasive surgery with preoperative treatment and colonoscopy at the time of hemorrhage.

The online version contains supplementary material available at 10.1007/s12328-025-02219-7.

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