Case Report
Copyright ©The Author(s) 2004. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 15, 2004; 10(18): 2769-2771
Published online Sep 15, 2004. doi: 10.3748/wjg.v10.i18.2769
Intestinal perforation after combined liver-kidney transplantation for a case of congenital polycystic disease
Tao Peng, Min-Hao Peng, Le-Qun Li, Yao-Liang Deng, Ding-Hua Yang, Bang-Yu Lu, Xi-Gang Chen, Ya Guo, Kai-Yin Xiao, Bin Chen, Qin Zhong, Min-Yi Wei
Tao Peng, Min-Hao Peng, Le-Qun Li, Ding-Hua Yang, Bang-Yu Lu, Xi-Gang Chen, Ya Guo, Kai-Yin Xiao, Bin Chen, Qin Zhong, Department of Hepatobiliary Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Yao-Liang Deng, Department of Urology Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Min-Yi Wei, Department of Pathology, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Peng Tao, Department of Hepatobiliary Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China. pengpang@hotmail.com
Telephone: +86-771-5352400
Received: January 10, 2004
Revised: January 23, 2004
Accepted: February 21, 2004
Published online: September 15, 2004
Abstract

AIM: 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.

CONCLUSION: 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.

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