Background <p>Cytomegalovirus (CMV) enteritis is an uncommon clinical entity that frequently predisposes to severe complications, such as gastrointestinal (GI) hemorrhage and perforation, and is associated with substantial mortality.</p> Case presentation <p>We herein present the management of a case of CMV enteritis in a patient with “relative immunosuppression”. The patient had a prior history of abdominal aortic replacement and bypass surgery for a type B aortic dissection, following which he developed acute kidney injury (AKI) stage 3 according to KDIGO guidelines. Approximately five weeks after the operation, he presented with massive gastrointestinal hemorrhage and was subsequently diagnosed with CMV enteritis. Treatment included exploratory laparotomy and antiviral therapy with ganciclovir combined with intravenous immunoglobulin, culminating in a successful recovery.</p> Conclusion <p>This case suggests that post-surgical AKI and stress-induced relative immunosuppression may be contributing factors for CMV enteritis in patients without traditional immunocompromise. CT imaging was valuable for early detection of small bowel bleeding in this patient. Prompt surgical intervention may be life-saving for CMV enteritis with life-threatening hemorrhage, providing essential pathological confirmation, while antiviral therapy remains first-line.</p> Clinical trial number <p>Not applicable.</p>