title: Perforated duodenal ulcer at seven years after heart-renal transplantation: a case report.
abstract: We experienced a rare case of perforated duodenal ulcer that occurred at seven years after heart-kidney transplantation. This patient is reported here together with a discussion of the etiology, the selection of treatment, and perioperative management. The patient was a 46-year-old man who presented with precordial pain. In 1995, he had undergone simultaneous heart and kidney transplantation in the United States and had been on long-term immunosuppressive and corticosteroid therapy. His precordial pain started from May 24, 2002. He was examined at our hospital on May 27 and underwent emergency surgery with a diagnosis of upper gastrointestinal perforation. A 4-mm perforation was observed on the anterior wall of the duodenal bulb and panperitonitis was also present. Patch closure of the perforation was performed by pulling the omentum over the defect. Perioperative management consisted of his usual immunosuppressants together with antacid therapy. The postoperative course was good and he was discharged on hospital day 15. In this patient, the mechanism of perforation was assumed to involve sudden irritation combined with poor circulation in the duodenum and tissue ischemia, as well as a decrease of mucosal protective factors based on long-term corticosteroid therapy. Perforated duodenal ulcer is a rare problem after heart transplantation. Because the time that elapses after perforation is an important determinant of the prognosis, early diagnosis and appropriate surgical repair are essential.
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Daini Hospital, Tokyo, Japan. narisu@dnh.twmu.ac.jp
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Naritaka
authors.forename: Kenji
authors.initials: K
authors.lastname: Ogawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimakawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Wagatsuma
authors.forename: Soichi
authors.initials: S
authors.lastname: Konno
authors.forename: Takao
authors.initials: T
authors.lastname: Katsube
authors.forename: Reiko
authors.initials: R
authors.lastname: Miyamoto
authors.forename: Kanako
authors.initials: K
authors.lastname: Hamaguchi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Hosokawa
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000284:Administration, Oral; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D001562:Benzimidazoles / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004630:Emergencies; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007262:Infusions, Intravenous; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D010439:Peptic Ulcer Perforation / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D064750:Rabeprazole; D012086:Reoperation; D013524:Surgical Flaps; D013536:Suture Techniques; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D007166:Immunosuppressive Agents; D064750:Rabeprazole; D011239:Prednisolone; D009853:Omeprazole; D016559:Tacrolimus