Pokorny Herwig, Plöchl Walter, Soliman Thomas, Herneth Andreas M, Scharitzer Martina, Pokieser Peter, Berlakovich Gabriela A, Mühlbacher Ferdinand
Division of Transplantation, Department of Surgery, University Hospital Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2003 Oct 31;115(19-20):732-5. doi: 10.1007/BF03040892.
Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a clinical entity characterized by massive nontoxic dilatation of the colon in the absence of mechanical obstruction and is associated with increased morbidity and mortality in the immunosuppressed patient. We present a case of a kidney transplant recipient developing a life-threatening condition with acute colonic pseudo-obstruction associated with radiologic findings of a linear pneumatosis intestinalis (PI). Urgent laparotomy and resection of the dilated cecum, colon ascendens and transversum was performed because of bowel necrosis with multiple serosal defects. Stool cultures and special stains for microorganisms were all negative, and there was no evidence for viral or fungal infection. The patient was discharged 31 days after transplantation with normal renal function. In conclusion, this steroid-induced ileus (pseudo-obstruction) is a potentially malignant early form of colonic dysmotility rarely reported in transplant recipients. Awareness and early recognition of the condition are critical for a successful outcome. Colonoscopic decompression can achieve reversal of colonic dilatation in most cases, but in some patients prophylactic laparotomy is indicated for prevention of the catastrophic consequences of perforation.
急性结肠假性梗阻（奥吉尔维综合征）是一种临床病症，其特征为结肠在无机械性梗阻的情况下发生大量无毒性扩张，且在免疫抑制患者中与发病率和死亡率增加相关。我们报告一例肾移植受者发生危及生命的急性结肠假性梗阻，并伴有肠壁积气（PI）的放射学表现。由于出现伴有多处浆膜缺损的肠坏死，遂紧急行剖腹探查术并切除扩张的盲肠、升结肠和横结肠。粪便培养及微生物特殊染色均为阴性，且无病毒或真菌感染的证据。患者在移植后31天出院，肾功能正常。总之，这种类固醇诱导的肠梗阻（假性梗阻）是结肠运动障碍的一种潜在恶性早期形式，在移植受者中很少有报道。对此病症的认识和早期识别对于取得成功的治疗结果至关重要。结肠镜减压在大多数情况下可使结肠扩张逆转，但在一些患者中，预防性剖腹探查术对于预防穿孔的灾难性后果具有指征。
