- 期刊
Spontaneous Small Bowel Perforation of a Kidney Transplant Recipient : Case Report and Literature Review
摘要
Small bowel perforation in kidney transplant recipients is a rare complication. Most cases of spontaneous bowel perforation after renal transplantation reported in the literature belong to the colon and are almost related to underlying lesions. In the present paper we present a 56-year-old man who experienced spontaneous small bowel perforation 8 months after a kidney transplant. We adopted anti-lymphocyte antibody as induction and used tacrolimus, mycophenolate sodium, and steroid for maintenance immunosuppressants. The recovery went well with the exception of one urinary tract infection episode and the patient was discharged 9 days after the operation. However, he suffered from epigastric dull pain with tarry stool eight months later. Immediate endoscopy and colonoscopy were arranged. The findings were superficial gastritis, esophageal diverticulum, and suspicious ulcerative mass near the Cecum. Computed tomography was arranged soon after, and it showed pneumoperitoneum with suspicious perforation in the terminal ileum. Emergent laparotomy was performed with hemicolectomy and ileocolostomy as first step due to severe abdominal contamination. Second step to restore bowel continuity by takedown of ileocolostomy was performed in three months later. The treatment plan worked without compromising the functionality of the graft. Thereafter we reported this rare case, reviewed the literature, and discussed the possible risk factors in kidney transplant recipients with spontaneous small bowel perforation.