title: Diagnosis and treatment of acute appendicitis after orthotopic liver transplant in adults.
abstract: OBJECTIVE
  The incidence of acute appendicitis after orthotopic liver transplant is low but difficult to differentiate from other posttransplant complications. We sought to summarize the clinical characteristics, diagnosis, and treatment of acute appendicitis during the early posttransplant stage.
  
  
  METHODS
  Data from 4 liver transplant recipients with acute appendicitis immediately after transplant and 4 patients with misdiagnosed appendicitis, between January 2000 and December 2007, were studied retrospectively.
  
  
  RESULTS
  The incidence of acute appendicitis immediately after orthotopic liver transplant was 0.49%. Four patients had right lower quadrant abdominal pain with fixed tenderness, rebound tenderness, and fever on the eighth, ninth, 11th, and 13th days after surgery. White blood cells counts were elevated in all patients. Appendectomies were performed on day 1 or 2 after the onset of symptoms. No appendicular perforations were found. All patients recovered well. After an exploratory laparotomy, the 4 patients originally misdiagnosed with appendicitis were correctly diagnosed with a duodenal diverticulum perforation (1 patient), a jejunum perforation (1 patient), and bile leakage (2 patients). Two of these patients died despite aggressive treatment.
  
  
  CONCLUSIONS
  The incidence of acute appendicitis immediately after orthotopic liver transplant is low and should be differentiated from other surgical complications, such as gastrointestinal perforation and bile leakage. Appendectomy is recommended in these patients as early as possible.
authors: Department of Organ Transplantation of First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Linwei
authors: L
authors: Wu
authors: Jianwei
authors: J
authors: Zhang
authors: Zhiyong
authors: Z
authors: Guo
authors: Qiang
authors: Q
authors: Tai
authors: Xiaoshun
authors: X
authors: He
authors: Weiqiang
authors: W
authors: Ju
authors: Dongping
authors: D
authors: Wang
authors: Xiaofeng
authors: X
authors: Zhu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult