Perforation of the colon in renal homograft recipients. A report of 11 cases and a review of the literature.
Colon perforation in renal transplant recipients is a potentially lethal condition that is amenable to appropriate medical and surgical treatment. The 11 cases seen at the Cleveland Clinic (incidence 1.1% of all renal transplant patients) and previous reports in the literature have been reviewed. The pathogenesis is related to a high incidence of diverticular disease in patients with polycystic kidneys and/or chronic renal failure, the effects of long-term immunosuppression, and the transplant procedure itself. The high mortality of this condition (61% overall) is related to the effects of immunosuppression on the response to sepsis and the surgical procedure used. Mortality has fallen from 88% (1970-1974) to 53% (1975-1979), and there are indications that it is continuing to fall. All four cases operated on here since 1980 have survived, giving a total operative mortality of 2/6, and all have maintained excellent allograft function. A high clinical index of suspicion, prompt exteriorization of the perforated colon, reduction of immunosuppression to minimal levels, and effective antibiotic coverage have all contributed to the declining mortality.
Church
J M
JM
Fazio
V W
VW
Braun
W E
WE
Novick
A C
AC
Steinmuller
D R
DR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004240:Diverticulum / Q000150:complications; D005244:Fecal Impaction / Q000150:complications; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009026:Mortality; D014184:Transplantation, Homologous / Q000009:adverse effects