RT Journal Article SR Electronic T1 Small bowel perforation secondary to CMV-positive terminal ileitis postrenal transplant JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e231662 DO 10.1136/bcr-2019-231662 VO 12 IS 11 A1 Kosuke Kato A1 Michelle Cooper YR 2019 UL http://casereports.bmj.com/content/12/11/e231662.abstract AB Cytomegalovirus (CMV) infection of the gastrointestinal tract is common in immunosuppressed patients; however, small bowel perforation from tissue-invasive CMV disease after many years of immunosuppressive therapy is a rare complication requiring timely medical and surgical intervention. We report a case of a postrenal transplant patient who presented to the emergency department with severe lower abdominal pain with CT of the abdomen/pelvis revealing a small bowel perforation. He underwent an emergent laparoscopic right hemicolectomy, and his histopathology of the terminal ileum was positive for CMV disease. He was successfully treated with intravenous ganciclovir postoperatively. We discuss the pathophysiology, histopathological features and treatment of CMV infection.