How To Treat Constipation Caused By Herpes
Ann Gastroenterol. 2012; 25(iv): 374–375.
Astute constipation due to abdominal herpes zoster: an unusual association
Siakir Mechmet
1st Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
Anastasia Micheli
1st Department of Internal Medicine, Democritus Academy of Thrace, Alexandroupolis, Greece
Hakan Netzadin
1st Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Hellenic republic
Konstantinos Mimidis
1st Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Hellenic republic
Received 2012 Jun 1; Accustomed 2012 Jun 2.
The clan of herpes zoster and acute constipation, or even colonic pseudo-obstacle, has received only scant attention in the published literature. Since 1950, 20 studies have been published with 28 patients reviewed. Significant co-morbidities were present in half of the patients while the time of skin eruption was variable when compared with the onset of the abdominal symptoms. The bulk of patients was observed and treated conservatively [1].
Herein we present a male patient with astute severe constipation and a concomitant painful pare eruption due to herpes zoster.
An 80-yr-onetime diabetic man was admitted to our Department for abdominal distention, discomfort and severe constipation for a week. He previously had regular bowel habits. One twenty-four hours before presentation he noticed erythema with the appearance of pocket-sized grouped vesicles involving the area of the T10-T12 dermatomes on the correct abdominal wall (Fig.i). Physical examination revealed scarce bowel sounds and abdominal distention. Laboratory testing was normal with the exception of a mild hyperglycemia (207 mg/dL). Neurological examination revealed no evidence of myelopathy that might cause severe bowel dysfunction. He had no bladder dysfunction. Abdominal roentgenogram did not show a pattern of ileus and a colonoscopy was unremarkable. The patient was diagnosed every bit having visceral neuropathy associated with herpes zoster infection. He was treated with Vancyclovir g mg t.i.d. with gradual resolution of symptoms during the adjacent two weeks.
A cutaneous vesicular eruption involving the area of the T8-T12 dermatomes on the right
The pathogenesis of herpes zoster-associated intestinal pseudo-obstruction has non still been fully elucidated. Direct viral interest of the colonic intrinsic autonomic nervous organisation has been thought to result in local inflammatory reaction, thus causing segmental spasm and proximal dilatation [two]. Another theory has been proposed to explain pseudo-obstruction with prominent colonic dilatation. The theory includes spread of the virus from the dorsal root ganglia to the thoracolumbal or sacral lateral columns resulting in autonomic balance, pause of sacral parasympathetic nerves, and resultant decrease in segmental colonic contractions [3]. Finally, direct involvement of the intrinsic colonic autonomic fretfulness (submucosal and myenteric plexuses) has also been discussed [4].
Herpetic neuralgia in a dermatomal distribution preceding the rash has long been recognized and noted to antedate the rash by up to 100 days, thereby creating significant diagnostic confusion [five]. The viral spread tin can involve not just the colon, but also the diaphragm, urinary tract, anus, and abdominal wall, and affect their motor activity [6].
The prognosis is mostly good. The need for antiviral therapy should be based on allowed condition of the patient, the dermatome involved and the likelihood of visceral dissemination. Conservative direction can attain complete resolution of symptoms [vii].
Biography
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Democritus University of Thrace, Alexandroupolis, Greece
Footnotes
Conflict of Interest: None
References
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Articles from Annals of Gastroenterology are provided here courtesy of The Hellenic Lodge of Gastroenterology
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959409/
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