Acute colonic pseudo-obstruction (Ogilvie's-syndrome) and pneumatosis intestinalis in a kidney recipient patient.
Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a clinical entity characterized by massive nontoxic dilatation of the colon in the absence of mechanical obstruction and is associated with increased morbidity and mortality in the immunosuppressed patient. We present a case of a kidney transplant recipient developing a life-threatening condition with acute colonic pseudo-obstruction associated with radiologic findings of a linear pneumatosis intestinalis (PI). Urgent laparotomy and resection of the dilated cecum, colon ascendens and transversum was performed because of bowel necrosis with multiple serosal defects. Stool cultures and special stains for microorganisms were all negative, and there was no evidence for viral or fungal infection. The patient was discharged 31 days after transplantation with normal renal function. In conclusion, this steroid-induced ileus (pseudo-obstruction) is a potentially malignant early form of colonic dysmotility rarely reported in transplant recipients. Awareness and early recognition of the condition are critical for a successful outcome. Colonoscopic decompression can achieve reversal of colonic dilatation in most cases, but in some patients prophylactic laparotomy is indicated for prevention of the catastrophic consequences of perforation.
Pokorny
Herwig
H
Division of Transplantation, Department of Surgery, University Hospital Vienna, Vienna, Austria. h.pokorny@akh-wien.ac.at
Plöchl
Walter
W
Soliman
Thomas
T
Herneth
Andreas M
AM
Scharitzer
Martina
M
Pokieser
Peter
P
Berlakovich
Gabriela A
GA
Mühlbacher
Ferdinand
F
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D003112:Colonic Pseudo-Obstruction / Q000139:chemically induced / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000150:complications* / Q000000981:diagnostic imaging; D011860:Radiography, Abdominal
D000305:Adrenal Cortex Hormones