Intestinal perforation after combined liver-kidney transplantation for a case of congenital polycystic disease.
OBJECTIVE
To highlight the intestinal perforation (IP), an uncommon and catastrophic complication after combined liver-kidney transplantation.


METHODS
Combined liver-kidney transplantation (LKTx) with left kidney excision and a cyst fenestration procedure on the right kidney were performed on a case of 46-year-old female with congenital polycystic disease (CPCD).


RESULTS
Two sites of IP were noted 40-50 cm proximal to ileocecal area during emergent laparotomy 10 d postoperatively. Despite aggressive surgical and medical management, disease progressed toward a fatal outcome due to sepsis and multiple organ failure 11 d later.


CONCLUSIONS
Long duration of operation without venovenous bypass, overdose of steroid together with postoperative volume excess may all contribute to the risk of idiopathic multiple IPs. Microbiology and pathology inspections suggested that the infected cyst of the fenestrated kidney might be one reason for the fatal intra-peritoneal infection. Thus for the CPCD patients who seem to be very susceptible to infectious complications, any sign of suspected renal-infection found before or during LKTx is indication for the excision of original kidney. And the intensity of immunosuppression therapy should be controlled cautiously.
Peng
Tao
T
Department of Hepatobiliary Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China. pengpang@hotmail.com
Peng
Min-Hao
MH
Li
Le-Qun
LQ
Deng
Yao-Liang
YL
Yang
Ding-Hua
DH
Lu
Bang-Yu
BY
Chen
Xi-Gang
XG
Guo
Ya
Y
Xiao
Kai-Yin
KY
Chen
Bin
B
Zhong
Qin
Q
Wei
Min-Yi
MY
D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D007690:Polycystic Kidney Diseases / Q000601:surgery*