SHM Converge Scientific Abstract ePoster Gallery-Acute Visceral Intestinal Paresis Secondary to Herpes Zoster

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A 74-year-old man from a rural hospital presented with three days of right flank/abdominal pain and constipation. His initial evaluation was unrevealing, and he was discharged on laxatives. He returned two days later with worsening abdominal discomfort, persistent constipation, abdominal distension, hypoactive bowel sounds, and a painful vesicular rash on the right flank in a dermatomal distribution (L1–L3), consistent with herpes zoster. Abdominal x-ray showed early/partial small bowel obstruction.<br /><br />Because a complete SBO would require transfer for surgery and the nearest major hospital was over 100 miles away, the patient was admitted locally for conservative management. He received laxatives and antiviral therapy. Repeat imaging with gastrografin two days later showed improvement in the small bowel, and by day four he was stable for discharge.<br /><br />The authors discuss herpes zoster as a reactivation of varicella-zoster virus, usually in older adults, and note that it can cause autonomic dysfunction and visceral neuropathy. While herpes zoster is classically associated with neuralgia and rash, it may also lead to gastrointestinal complications such as pseudo-obstruction or intestinal paresis. The suspected mechanism is direct neuronal injury affecting the enteric nervous system or muscularis propria.<br /><br />This case highlights a rare manifestation of zoster-induced intestinal paresis presenting as early/partial SBO. Recognition of the dermatomal rash helped identify the underlying cause and guided appropriate inpatient treatment, avoiding unnecessary costly transfer and intervention. The report emphasizes the importance of considering herpes zoster in patients with abdominal symptoms and bowel dysmotility, especially in rural settings where surgical resources are limited.

Asset Subtitle

Natalie S. North-Cole

Meta Tag

Author List Dr. Alexander Phillips, Luke Sanchez, Natalie S. North-Cole

Category Clinical Vignettes

Concept Herpes Zoster

Concept Visceral Autonomic Dysfunction

Concept Intestinal Paresis

Concept Dermatomal Vesicular Rash

Concept Varicella-Zoster Reactivation

Distinguished Non-Finalist

Presenter Organization Burrell College of Osteopathic Medicine

Presenting Author Natalie S. North-Cole

Track Adult

Keywords

herpes zoster

small bowel obstruction

intestinal paresis

abdominal pain

constipation

dermatomal rash

varicella-zoster virus

visceral neuropathy

rural hospital

conservative management

Herpes Zoster

Visceral Autonomic Dysfunction

Intestinal Paresis

Dermatomal Vesicular Rash

Varicella-Zoster Reactivation