- 期刊
Colon Perforation as Initial Manifestation of Post-transplant Lymphoproliferative Disorder Following Kidney Transplant: Report of a Case
腎移植後淋巴增生疾病造成結腸穿孔：病例報告
摘要
一個三十九歲的女性在接受腎臟移植十一個月之後發生了兩天的急性腹症。經過緊急剖腹探查手術之後，發現橫行結腸穿孔以及左側卵巢腫瘤。我們將結腸清瘡之後直接施行橫結腸迴狀造口(loop colostomy of transverse colon)以及左側卵巢切除。病人在術後恢復良好，沒有發生併發生。病理報告診斷爲多形性移植後淋巴增生疾病(polymorphic posttransplant lymphoproliferative disorder)。接受了四個療程的抗CD-20抗體治療，並將免疫抑制劑的劑量減半之後，我們發現腫瘤消除，獲得了完全的反應。雖然移植後淋巴增生疾病以大腸穿孔的表現不多，但是發生後對病人會有生命的威脅，所以對於高危險或有懷疑的病人早期的偵測和積極的檢查是很重要的。
關鍵字
無資料並列摘要
A 39 year-old female suffered 2 days of abdominal pain approximately 11 months after cadaveric kidney transplantation. Emergent laparotomy revealed transverse colon ulceration with perforation and left ovarian tumor. Ulceration debridment, loop colostomy of the transverse colon, and left oophorectomy were carried out. Her post-operative course was uncomplicated. The pathological examination revealed polymorphic post-transplant lymphoproliferative disorder. Consequently immunosuppressants were reduced to half of the original dose and anti CD-20 antibody was given to this patient. Complete remission was noted after 4 doses of anti-CD-20 antibody. Colon perforation as the initial presentation of post-transplant lymphoproliferative disorder (PTLD) is unusual. However, early detection is necessary and aggressive investigation should be considered in suspicious cases with a high-risk of PTLD.