Postoperative abdominal herpes zoster complicated by intestinal obstruction: A case report

Abstract

Background: Intestinal obstruction is a common occurrence in clinical practice. However, the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare. In the diagnostic and treatment process, clinicians consider it crucial to identify the primary causes of its occurrence to ensure effective treatment and avoiding misdiagnosis.

Case summary: Herein, we present the case of a 40-year-old female patient with intestinal obstruction who underwent laparoscopic appendectomy and developed herpes zoster after surgery. Combining the patient's clinical manifestations and relevant laboratory tests, it was suggested that the varicella zoster virus reactivated during the latent period after abdominal surgery, causing herpes zoster. Subsequently, the herpes virus invaded the visceral nerve fibers, causing gastrointestinal dysfunction and loss of intestinal peristalsis, which eventually led to intestinal obstruction. The patient was successfully treated through conservative treatment and antiviral therapy and subsequently discharged from the hospital.

Conclusion: Pseudo-intestinal obstruction secondary to herpes zoster infection is difficult to distinguish from mechanical intestinal obstruction owing to various causes. In cases of inexplicable intestinal obstructions, considering the possibility of a viral infection is essential to minimize misdiagnosis and missed diagnoses.

Keywords: Case report; Herpes zoster; Ogilvie syndrome; Peripheral motor neuropathy; Pseudo-intestinal obstruction.

Figure 1

Clusters of red rashes. Clusters of red rashes can be seen on the patient's right lower abdomen (as shown by the arrow).

Figure 2

Abdominal upright plain film. Gas accumulation in the abdominal intestine, and scattered fluid levels are seen, indicating intestinal obstruction.

Figure 3

Representative whole-abdominal computed tomography images. A: Significant dilation and fluid accumulation of the bowel; B: An arc-shaped hypodense shadow under the capsule of the liver at the point indicated by the arrow; C: Fluid accumulation in abdominal cavity by the arrow; D: Fluid accumulation in pelvic cavity by the arrow.

Figure 4

Representative coronal plane whole-abdominal computed tomography image. The position of the Hem-Lock clamp during the patient's previous laparoscopic appendectomy.