Dehghani Seyed Mohsen, Nikeghbalian Saman, Kazemi Koorosh, Dehghani Masood, Gholami Siavash, Bahador Ali, Salahi Heshmatollah, Malek-Hosseini Seyed Ali
Organ Transplantation Center, and Gastroenterohepatology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Pediatr Transplant. 2008 Mar;12(2):146-9. doi: 10.1111/j.1399-3046.2007.00829.x.
Bowel perforation is one of the causes of mortality after pediatric liver transplantation. The aim of this study was to evaluate the incidence, risk factors, clinical presentations, and outcomes of bowel perforation in pediatric liver recipients. This is a retrospective analysis of all pediatric patients who underwent liver transplantation at a single liver transplant center in Iran between 1999 and 2006. During this period 72 liver transplantations were performed in children <18 yr. Twenty-two children underwent 33 re-explorations after liver transplantation. Five bowel perforations occurred in four children (incidence, 6.9%). One patient required two re-explorations. The median time between liver transplantation and the diagnosis of the bowel perforation was seven days. All patients had abdominal distention before re-exploration. The sites of perforation were jejunum (n = 3) and ileum (n = 2), and simple repair was performed in all cases. Three children had a history of prior Kasai operation. One of them received high dose of methylprednisolone before bowel perforation. Two children expired after bowel perforation (mortality rate, 50%). Bowel perforation is relatively frequent after pediatric liver transplantation. Among risk factors, prior Kasai operation may have a role. We observed that abdominal distention is a sign of bowel perforation and a high index of suspicion is required for rapidly diagnosis of this complication. The outcome of bowel perforation is poor and its mortality is high. Further studies are needed to establish real risk factors for this complication.
肠穿孔是小儿肝移植术后的死亡原因之一。本研究旨在评估小儿肝移植受者肠穿孔的发生率、危险因素、临床表现及预后。这是一项对1999年至2006年间在伊朗一家单一肝移植中心接受肝移植的所有小儿患者的回顾性分析。在此期间，对18岁以下儿童进行了72例肝移植手术。22名儿童在肝移植后接受了33次再次探查。4名儿童发生了5次肠穿孔（发生率为6.9%）。1例患者需要进行两次再次探查。肝移植与肠穿孔诊断之间的中位时间为7天。所有患者在再次探查前均有腹胀。穿孔部位为空肠（n = 3）和回肠（n = 2），所有病例均进行了简单修补。3名儿童有既往Kasai手术史。其中1名在肠穿孔前接受了大剂量甲泼尼龙治疗。2名儿童在肠穿孔后死亡（死亡率为50%）。小儿肝移植术后肠穿孔相对常见。在危险因素中，既往Kasai手术可能起一定作用。我们观察到腹胀是肠穿孔的一个体征，对于快速诊断这一并发症需要高度怀疑。肠穿孔的预后较差，死亡率较高。需要进一步研究以确定这一并发症的真正危险因素。
