Koneru B, Selby R, O'Hair D P, Tzakis A G, Hakala T R, Starzl T E
Department of Surgery, University of Pittsburgh, Pa.
Arch Surg. 1990 May;125(5):610-3. doi: 10.1001/archsurg.1990.01410170056012.
Nonobstructing colonic dilatation has not been commonly reported following renal transplantation, and colon perforations carry a high morbidity and mortality in this population. During a 7-year period, nonobstructing colonic dilatation developed in 13 adults 1 to 13 days after renal transplantation. Twelve (92%) of the 13 had poorly functioning allografts. Five (83%) of the 6 with and 2 (29%) of the 7 without colonoscopy had resolution of nonobstructing colonic dilatation. Of the seven right-sided colon perforations during this period, six were associated with nonobstructing colonic dilatation. An additional 4 patients had diverticular perforations in the left colon. Of a total of 11 patients with colon perforation, 7 had surgery within 24 hours of the perforation and 6 (86%) of these survived. Only 1 (25%) of the 4 having surgery more than 24 hours later survived. Six of the survivors retained functioning allografts. Nonobstructing colonic dilatation seems to be a potential complication of poor graft function after renal transplantation, and colonoscopy is effective in its treatment. In patients with colon perforations, early surgery and reduced immunosuppression are essential in decreasing mortality.
肾移植后非梗阻性结肠扩张并不常见，且结肠穿孔在该人群中具有较高的发病率和死亡率。在7年期间，13名成年人在肾移植后1至13天出现非梗阻性结肠扩张。13例中有12例（92%）移植肾功能不佳。6例行结肠镜检查的患者中有5例（83%）、7例未行结肠镜检查的患者中有2例（29%）的非梗阻性结肠扩张得到缓解。在此期间的7例右侧结肠穿孔中，6例与非梗阻性结肠扩张有关。另外4例患者左结肠出现憩室穿孔。在总共11例结肠穿孔患者中，7例在穿孔后24小时内接受了手术，其中6例（86%）存活。穿孔后24小时以上接受手术的4例患者中仅1例（25%）存活。6名幸存者的移植肾仍有功能。非梗阻性结肠扩张似乎是肾移植后移植肾功能不佳的一种潜在并发症，结肠镜检查对其治疗有效。对于结肠穿孔患者，早期手术和减少免疫抑制对于降低死亡率至关重要。
