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.
Department of Hepatobiliary Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China. pengpang@hotmail.com
Tao
T
Peng
Min-Hao
MH
Peng
Le-Qun
LQ
Li
Yao-Liang
YL
Deng
Ding-Hua
DH
Yang
Bang-Yu
BY
Lu
Xi-Gang
XG
Chen
Ya
Y
Guo
Kai-Yin
KY
Xiao
Bin
B
Chen
Qin
Q
Zhong
Min-Yi
MY
Wei
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*